Nov 07, Colombo: Cancer experts from the International Atomic Energy authority (IAEA), the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) have assessed Sri Lanka's comprehensive cancer control program and have provided options for a multipronged strategy to strengthen cancer care in the country.
The assessment is the outcome of an 'imPACT Review' mission, the second to the country, hosted by the Sri Lankan National Cancer Control Programme Directorate under the leadership of the Ministry of Health, Nutrition and Indigenous Medicine last week.
"This imPACT Review is very timely for the Government of Sri Lanka as the assessment will help us in updating the National Cancer Control Programme and defining the plan of action for the next five years with concrete targets to reduce the number of new cancer cases. This will improve the survival and the quality of life of cancer patients and their families," said Dr. Rajitha Senaratne, Sri Lanka's Minister of Health.
"Our objective is to advance the health system to provide more equitable, quality and comprehensive cancer services that will directly impact peoples' lives."
The experts' main recommendations focused on putting a training system in place to enhance the skills of oncologists, medical physicists and radiation therapists, as the country moves to more advanced radiotherapy; and on the elaboration of an action plan and a budget for the implementation of national cancer control activities, the IAEA said in a statement.
"Cancer care services for patients have advanced significantly since 2008 when a similar IAEA imPACT Review was conducted in the country," said Geraldine Arias de Goebl, Head of the Cancer Control Review and Planning Section at the IAEA.
Sri Lanka has nine radiotherapy centers, and when the country completes its planned expansion program, there will be 12. This will increase the number of radiotherapy machines from 16 to 27, covering all provinces. "This is a significant demonstration of commitment to cancer control by the Government of Sri Lanka," de Goebl said.
According to the International Agency for Research on Cancer (IARC), breast and cervical cancers constitute a third of all new cancer cases among females in the country, with lip, mouth and lung cancers accounting for a quarter of all cancer in men - types of cancers that are related to smoking.
"Overall, the cancer burden is increasing: by 2030, the number of Sri Lankans developing the disease each year is expected to rise by 23%," said Catherine Sauvaget from IARC who joined the Review mission.
Enhancing cancer care
The Sri Lankan government has prioritized cancer as a major health issue and has been working with the IAEA to address it for over 40 years. Measures include providing free and publicly accessible cancer care to patients. The IAEA is providing technical cooperation assistance in specialist training, expert advice and procurement of equipment.
IAEA support has also focused on establishing cancer diagnostic capabilities in Sri Lanka's Northern Province, with a view to expanding it to nuclear medicine imaging. This capability is already available in Sri Lanka's Central and Southern Provinces.
The Ministry of Health requested the 2019 imPACT Review to establish an evidence-based analysis with recommendations to assist in decision-making and planning for its proposed major enhancement of cancer care services. IAEA support was requested for assessments in areas such as:
• Strengthening of treatment services, in particular radiotherapy, to fill the gaps in provinces where services are not currently provided;
• Upgrading of equipment with advanced technology and related staff training; and,
• Enhancing the design of cancer early detection services and raising awareness among the health professionals and the population.
The experts involved in the mission reviewed all areas of the country's cancer control planning, registration and surveillance, prevention and early detection, treatment and palliative care. Safety and security issues in cancer centers delivering nuclear medicine and radiotherapy were also discussed. The safety of radioactive sources was the subject of a separate IAEA mission conducted in April this year.
According to WHO, cancer represents 14% of all deaths in the country, which is in line with global trends. "WHO will continue providing support to Sri Lanka in tackling non-communicable diseases and strengthening cancer care, in a holistic and patient-centered approach. An important reform in this regard is to strengthen primary healthcare to deliver multidisciplinary, integrated and comprehensive services for cancer control, from primary prevention to early detection, timely diagnosis and treatment, and palliative care," said Razia Narayan Pendse, WHO Country Representative for Sri Lanka.
The mission was the 101st imPACT Review conducted by the IAEA's Programme of Action for Cancer Therapy since 2005. More than a fifth of all imPACT Reviews have been conducted in Asia.