WHO Model for Cancer Control

WHO’s public health model for cancer control may be further illustrated in the diagrams below for an easier conceptual grasp of the whole process. A national cancer control program (NCCP) is metaphorically like an old-fashioned wooden kitchen chair. Such a chair has four legs, a seat, and a back. As you imagine yourself sitting in the chair, the right front leg represents prevention, the rear right leg is screening, the rear left leg is treatment and the front let leg is palliative care. There is a supportive horizontal strut between the back two legs emphasizing that screening and treatment are inextricably linked. Some countries try to establish screening programs without adequate treatment capabilities and then wonder why mortality rates are not falling even though downstaging is occurring (patients are being picked up at earlier stages of their disease). There is no point in setting up a screening program if the patients identified cannot be given adequate and timely treatment. Conversely curative treatment requires that patients be identified at an early stage of their disease when the tumor is localized and treatable, and this requires screening. Treatment and screening are interdependent. This is why in the first diagram below treatment is shown below and linked to screening.

But four legs alone will not make a functional chair. Not recognizing this, countries may establish four unlinked or vertical independent programs for prevention, screening, treatment and palliation, often reporting independently to a ministry of health and even competing with one another for resources. Sometimes prevention and screening are taken over by public health and treatment and palliation by the medical treatment system. The two use conflicting paradigms (populations for public health and individual patient are for medicine) and conflict arises again over policy and resources. Worse, in either case patients suffer from the lack of communication and coordination across the programs and fall between the cracks to their detriment. A seat must be provided to join the four legs into a functional chair. In this metaphor the seat represents the national managerial system of an NCCP, its organizational structure and governance.

But a fully functional chair requires a back. Here the back represents the entire infrastructure that needs to be in place for the programs to function.

Finally, the same model can be thought of in concentric circles. The ideas is to emphasize the narrowing spheres of influence of each of the component programs of cancer control in terms of the proportions of the population or numbers of patients served. Of all those screened, only a fraction is diagnosed. Of those diagnosed, not all will be eligible for curative treatment. Of those treated a subset will eventually require palliative care. The subsets become smaller as one moves from the population perspective of public health measures like prevention and screening to that of individual patients with treatment or palliative care.

Assess magnitude of the cancer problem (incidence, prevalence, mortality)

Evaluate possible strategies for cancer control

Choose priorities for initial cancer control activities

Set measurable cancer control objectives

Primary Prevention

*Tobacco control
*Health education on lifestyles (diet, sun exposure, sexual habits)
*Hepatitis B vaccination

Early Diagnosis & Screening

Therapy

*surgery
*radiotherapy
*chemotherapy (essential drugs)

Palliative Care

*pain relief
*symptom management
*improved quality of life
*home care
*terminal care