Setting Up a Cancer Centre: A WHO–IAEA Framework

Abstract

Cancer is a leading cause of death worldwide, accounting for nearly ten million deaths in 2020. The cancer burden is growing globally, exerting tremendous physical, emotional and financial strain on individuals, families, societies and health systems. Many of these systems in low and middle income countries are being challenged in managing this burden, leading to large numbers of cancer patients around the world without access to timely, high quality diagnosis or the required treatment. A proper diagnosis is a fundamental step for appropriate and effective treatment because every type of cancer requires a specific treatment regimen. Treatment usually includes radiotherapy, chemotherapy and/or surgery. Determining the goals of treatment is an important step. The primary goal is to cure cancer or to prolong life for a considerable period of time. Improving the patient’s quality of life is also an important goal. This can be achieved by supporting the patient’s physical, psychosocial and spiritual well-being and providing palliative care during the terminal stages of cancer. The basics of delivering cancer care involve empowering and engaging communities; improving health literacy; enhancing diagnostic capacity, including pathology and referral mechanisms; and arranging access to and coordinating appropriate treatment. Cancer centres are a major resource in ensuring the success of this comprehensive approach to dealing with cancer and can be planned appropriately. In 2018 the IAEA and the World Health Organization (WHO) decided to issue a joint publication to guide the establishment of a cancer centre. The aim was to help physicians, policy makers and programme managers develop cancer treatment facilities in a phased manner. As many countries are developing or expanding such facilities, the goal was to present the critical issues and factors to be considered in planning and/or expanding cancer treatment services. A group of experts from the IAEA and WHO and their Member States met at an IAEA technical meeting in Vienna in February 2019. Follow-up meetings were held in April, May and July 2019. A consultancy meeting of 25 experts was organized in Vienna in November 2019, where the draft report was reviewed and finalized. This guide is a supplement to a more comprehensive publication and highlights the key elements of that version. It describes the features of multidisciplinary cancer care and details the infrastructure, human resources and equipment needed for different services, with the aim of helping national programme managers and planners as they expand their cancer care capacity. This framework is intended to be implemented in accordance with local conditions and resources, thereby systematically improving the capacity for cancer care in a particular country. This publication was made possible by contributions and reviews from a broad range of experts. The IAEA wishes to acknowledge in particular the contributions of B. Mikkelsen and C. Varghese (project focal point) of WHO. The technical officer responsible for this publication was M. Abdel-Wahab (IAEA).