Abstract
Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g.,age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance(personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival ratesvary considerably as a function of geography, opportunity, wealth and development. Quality of life is impactedsimilarly, such that aspects of care related to coordination and integration of care across primary, communityand specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer;and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-incomeresource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer careand treatment through three plenary presentations and five interactive workshop discussions: 1) establishing,implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community,and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4)issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. Anumber of recommendations were proposed relating to capacity-building (standards and guidelines, protocols,new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping andanalysis of variations in primary, community and specialist care across countries with identification of modelsfor effective, integrated clinical practice; the importance of considering the introduction, or expansion, ofevidence-supported clinical practices from the perspectives of health economic impact, the value for healthresources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom controland integration of these services into national cancer control plans; the need for public education to reduce thefear and stigma associated with cancer so that patients are better able to make informed decisions regardingfollow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasingnumber, the necessity to integrate survivorship into cancer control plans and the economic and societal value offunctional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients isboth a ‘systems’ challenge and solution, requiring the consideration of patient and family circumstances, societalvalues and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importanceassigned to health and illness management within public policy.
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