Minimum Requirements for the Development of a Cancer Care Program in LMICs: A Scoping Review.

Study Rationale Cancer is a leading cause of death globally and has been established as a public health priority. In 2020, there were 19 million new cases of cancer and 10 million cancer-related death1. Low- and middle-income countries (LMICs) are affected at a substantially greater degree by cancer’s morbidity and mortality, compared to high income countries (HICs)2. The consequence of this inequity and incapacity to provide cancer care is avoidable cancer-related mortalities, which are predicted to rise as new cancer cases are expected to surpass 30 million by 2040 with the greatest increase in LMICs3. There are major deficits in the provision of cancer services across the cancer care continuum in LMICs, from diagnosis to treatment and survivorship care. The World Health Organization (WHO) estimates that over half the world’s population does not have access to radiology services4 required for cancer work-up and staging. In 2019, only 26% of low-income countries (LICs) reported having public-sector pathology services. In lacking work-up and diagnostic services, cancer patients in LMICs present with later stage, incurable disease2. More than 77% of Uganda’s breast cancer patients present with stage III or IV disease6, compared with 11% in the United States (US)7. Strengthening cancer care is seen as a monetarily intensive endeavor for resource constraint nations, associated with high capital investments and upfront costs. However, scaling up effective diagnostic and therapeutic cancer services have extensive economic and societal benefits. One US dollar invested in cancer care leads to a direct productivity return of $2.30 and a full return based on both direct productivity and societal gains of $9.508. The development of cancer care centers through which cancer care can be upscaled and promoted are an integral necessity in achieving universal health equitable global cancer care through universal health coverage, as articulated in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 and in Target 3.4 of the UN Agenda for Sustainable Development9,10. Select groups have published their recommendations on major considerations required to establish a cancer care program, including the World Health Organization (WHO)11, International Atomic Energy Agency (IAEA)11, Association of Radiotherapy and Oncology of the Mediterranean Area (AROME)12 and World Bank Group13. Such guidelines and expert recommendations are useful once a decision to pursue cancer program development is established. However, a needs and resources assessments are necessary in preliminary phases of decision-making. Cancer centres and programs are often established within existing healthcare centres to leverage available infrastructure and resources, allowing to overcome high upfront costs of healthcare system development. Therefore, it is critical to have guidance on standards of a cancer program’s architectural and infrastructural requirements to distinguish whether available infrastructural resources are capable of supporting new cancer care initiatives. Study Objective The objective of this study is to summarize the physical, architectural infrastructure requirements for a cancer care center in low resource settings. “Cancer care center” does not have a widely accepted definition. This study accepts the definition offered by the WHO and IAEA: “At its core, a cancer centre provides coordinated, multidisciplinary care that includes all services generally available in a country, including for example, pathology, radiotherapy, surgery, and systemic therapy. It may thereby act as a ‘cancer centre’ even if other non-oncology services are provided in the same facility.11” The aim of this scoping review is to identify commonalties in suggestions for cancer care center infrastructure shared by reputable international organizations and experienced institutions. References 1. International Agency for Research on Cancer, World Health Organization. The Global Cancer Observatory, Globocan. Available at: https://gco.iarc.fr 2. Meara JG, Leather AJM, Hagander Lars, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 2015; 386:569-624. 3. Zafar SN, Fatmi Z, Iqbal A, Channa R, Haider AH. Disparities in access to surgical care within a lower income country: an alarming inequity. World J Surg 2013; 37: 1470–77. 4. Hanche-Olsen TP, Alemu L, Viste A, Wisborg T, Hansen KS. Trauma care in Africa: a status report from Botswana, guided by the World Health Organization’s “Guidelines for Essential Trauma Care”. World J Surg 2012; 36: 2371–83. 5. WORLD HEALTH ORGANIZATION, Noncommunicable Disease (NCD), Repository Country Capacity Survey (2019) https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs 6. Gakwaya A, Kigula-Mugambe JB, Kavuma A, et al. Cancer of the breast: 5-year survival in a tertiary hospital in Uganda. Br J Cancer 2008; 99: 63–67. 7. Sariego J. Patterns of breast cancer presentation in the United States: does geography matter? Am Surg 2009; 75: 545–49. 8. World Health Organization. Report on Cancer: Setting Priorities, Investing Wisely and Providing Care for All. 2020. 9. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020). 2013. 10. United Nations. The 2030 Agenda for Sustainable Development (2015), https://sdgs.un.org/goals 11. World Health Organization, International Atomic Energy Agency. Setting up a cancer centre: a WHO-IAEA framework. Vienna. 2022. 12. AROME. Guidelines, minimal requirements and standard of cancer care around the Mediterranean Area: Report from the Collaborative AROME (Association of Radiotherapy and Oncology of the Mediterranean Area) working parties. Critical Reviews in Oncology/ Hematology. 2011;78:1-16. 13. Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: Disease Control Priorities, Third Edition (Volume 3). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015.

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