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Republic of the Marshall Islands National Comprehensive Cancer Control Plan 2007-2012

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Republic of the Marshall Islands National Comprehensive Cancer Control Plan 2007-2012 Republic of the Marshall Islands National Comprehensive Cancer Control Plan 2007-2012 l C o m p r e h n a n t r o l e n i o C o P r s t r o g i v a e r e N c a n m a C Ewor- Kojat- dikdik R e s p d u M n b i t h l a l i n i a l I s c s t r H e l o f y o f a l t h e M a r s h Republic of the Marshall Islands National Comprehensive Cancer Control Plan 2007-2012 Republic of the Marshall Islands National Comprehensive Cancer Control Program Director Neiar Kabua Ministry of Health PO Box 16 Majuro, Marshall Islands 96960 Phone: 692-625-4955 Fax: 692-625-3432 Email: [email protected] Contents 6 Mission & Vision Statements 6 Mission Statement 7 Vision Statement 8 Messages from Secretary 9 Introduction 21 Marshall Islands Demographics 22 The Nuclear Legacy 24 The Burden of Cancer in Marshall Islands 30 Primary Prevention 31 Tobacco Use and Exposure 36 Alcohol 40 Nutrition, Physical Activity, and Obesity 49 Infectious Agents 55 Environmental Carcinogens 58 Secodary Prevention 59 Screening Breast Cancer 62 Screening Cervical Cancer 64 Early Detection 66 Medical Care 66 Access to Cancer Care 67 Availability of Cancer Care in Marshall Islands 70 Quality of Cancer Care 71 Pathway to Care 76 Survivorship 77 Psychosocial Services, Palliative Care, and End-of-Life Care 82 Integrating Complementary Therapy into Cancer Care 84 Cancer Registry 84 Surveillance and Data Collection 90 Evaluation 92 Appendices 93 Appendix A: Ministry of Health Fifteen-Year Strategic Plan (2001-2015) 94 Appendix B: Comprehensive Cancer Control Coalition 95 Appendix C: 2002 RMI/WHO STEPwise NCD Risk Factor Survey 96 Endnotes/References Mission & Vision Statements cancer survivors and volunteers, valuing their Mission Statement commitment, experience, insight, and knowledge The Republic of the Marshall Islands National as integral to better fulfilling NCCCP’s mission. Comprehensive Cancer Program is committed to minimizing the impact of cancer, thereby improving • Exemplifying and promoting the highest level the quality of life for communities of the Marshall of public accountability and social responsibility Islands by: through self-evaluation and continuous improvement within the constraints of sound • Delivering innovative, compassionate, accessible, fiscal management and prudent use of resources community-based medical care and support to to fill the gap in services. individuals and families affected by cancer with measurable impact on patient outcomes. • Decreasing the incidence of cancer by encouraging prevention programs and early detection through appropriate screening and medical services. • Capacity building for the health care workforce through additional training and certification to better meet cancer screening, early detection and treatment needs. • Empowering clients by providing high quality, culturally relevant, linguistically appropriate, evidence based cancer health education resources, so the public can make informed choices. • Facilitating psychological and counseling services, as well as community peer groups to provide physical and spiritual support. • Educating policymakers and vigorously undertaking governmental and departmental legislation and advocacy on all matters relating to cancer care, support and education. • Seeking partnerships and collaborations and providing meaningful opportunities for Vision Statement The Republic of the Marshall Islands National Comprehensive Cancer Control Program’s vision is to be the preeminent cancer health services provider in the RMI by ensuring that • All cancer prevention services are established and provided • Innovative framework for early detection and prevention are established and provided • Feasible Cancer treatment services are established and provided • Palliative care is provided to all cancer patients • Support services are provided for cancer patients, survivors and their loved ones Thereby provide efficient cancer health services in country to the people of RMI and thereby maximizing effective utilization of scarce resources available. NCCCP’s focus is, first and foremost, to provide quality medical care that meets the unique needs of the cancer patients. By advocating governmental and departmental policy and legislation, and by developing awareness through culturally relevant community education resources, NCCCP provides compassionate care and support services for patients and their families in the isolated communities we serve. b i l i t y A s i j m o n u p u s r e E R j d A e d r w a o h j S J a i m s i o r h t E l d a d e o H MIN TH ISTRY OF HEAL 1979 Messages from Secretary Cancer prevention and screening for early detection are key priorities of the Marshall Islands Ministry of Health’s National Comprehensive Cancer Control Plan because they are the most effective long-term strategies to reduce the general burden of cancer, minimize the cost of cancer treatment, and most importantly, alleviate human suffering. Aspects of general health can be improved and many cancers avoided by adopting a healthier lifestyle. In fact, it is estimated that more than 80% of cancers may be attributed to environmental, social and cultural practices and factors. This is why education and primary prevention on the basis of addressing major health determinants is a key priority for the Marshall Islands. Investment in preventive measures is the most effective long-term weapon we have in the fight against cancer. Regular and systematic examinations have the potential to significantly reduce mortality and improve the quality of life for people living with cancer by detecting the disease at an early stage, when it is more responsive to less aggressive treatment. While late-stage cancer treatment can be complex and expensive, prevention and early diagnosis are highly cost effective, and can often be performed without advanced technologies. It is far more costly to pay for cancer treatments and support than it is to provide early detection and cessation services. With less funding needed for treatment, due to effective prevention and early detection, more resources can be allocated for public education, screening services, survivors’ support groups and palliative care. Cancer survivors are key advocates of the National Plan. Cancer is a disease that touches so many of us, either directly or indirectly. The important fields of primary prevention, effective screening programs, data collection and information sharing are some of the key areas where we can really make a difference. This National Plan is a culmination of concentrated efforts by many dedicated stakeholders and is the Ministry of Health’s pathway to address the continuum of cancer care in the Marshall Islands. Justina R. Langidrik MPH Principal Investigator Secretary of Health Introduction Although progress has been made in Marshall Islands to reduce the burden of cancer, much still remains to be done. Declining death rates mean that Marshall Islands’ population is aging. Overall cancer incidence and mortality increase with age. The population of RMI is very young with over 64% under the age of 24, and an average population age of 17.8 years.6 But, as the population of Marshall Islands ages, the burden of cancer will increase. Cancer is not an inevitable result of aging. Although some of the risk factors for cancer, such as aging and heredity, cannot be controlled, others can. According to the Harvard Center for Cancer Prevention, over half of all cancer deaths may be attributed to behavior-related factors such as tobacco use, diet, obesity, and sedentary lifestyle. Continued progress in overall cancer prevention and control will depend not only on gaining new knowledge through research, but more extensively applying current knowledge to reduce known risk factors and promote effective preventive, therapeutic, and palliative care services. The Burden of Cancer in Marshall Islands Cancer has consistently been one of the top five leading causes of death. However, truly accurate cancer data is still being collected. The National Registry is in its infancy and its staff requests additional training. Obtaining reports from the widespread, isolated outer islands is a challenge, and protocol must be streamlined to facilitate transfer of information between various offices. A staff pathologist conducts histopathology, cytology and autopsy pathology. However, an autopsy is performed for only two reasons: Year Reported Male Female #1 #2 #3 #4 #5 Cervical Breast Thyroid 2002 40 14 26 Liver (10%) Lung (5%) (28%) (18%) (6%) Cervical Breast Thyroid 2003 46 22 24 Lung (13%) Liver (11%) (22%) (11%) (9%) Cervical Lung Breast Thyroid 2004 54 22 32 Colon (7%) (13%) (13%) (13%) (7%) Uterine Cervical Thyroid 2005 44 19 25 Lung (16%) Kidney (7%) (11%) (9%) (7%) Breast Cervical Thyroid 2006 35 13 22 Colon (9%) Lung (6%) (20%) (17%) (9%) Introduction Introduction for an unknown cause of death (upon request by linguistically relevant approach for solving cancer police) or to determine the extent of a disease (upon problems. request of physician). ▶ Using available data and research results and Comprehensive Cancer Control collecting needed data to identify gaps in services and priorities among the wide range of cancer Comprehensive cancer control (CCC) is defined as issues (from prevention through survivorship or an integrated and coordinated approach to reducing end-of-life). cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, ▶ Implementing evidence-based solutions to and palliation. These efforts encourage healthy ensure that current knowledge is applied in a lifestyles, promote recommended cancer screening cost-effective manner to achieve the best possible guidelines and tests, increase access to quality cancer outcomes. care, and improve quality of life for cancer survivors. ▶ Using limited resources more efficiently to develop a pathway to screening and treatment Rationale for Comprehensive Cancer Control by integrating and coordinating efforts to Planning reduce duplication and improve overall capacity Comprehensive cancer control represents a new throughout Ministry of Health’s existing program approach to nationwide cancer efforts.
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