Cancer Systems and Control for Health Professionals E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: UICC
• Sprache: Englisch

Seitenzahl: 612

Veröffentlichungsjahr: 2025

Beschreibung

First-of-its-kind resource exploring how cancer care fits into a general health system, contributed to by internationally eminent interdisciplinary experts

Cancer Systems and Control for Health Professionals delivers a comprehensive overview of the subject of cancer control, cancer services and systems organization and performance, principles of care delivery, cancer policy and social issues. Its distinguishing feature lies in its systematic exploration of cancer through a holistic lens, emphasizing systems-level understanding and the application of cancer control theory principles to address its complexities.

Through this holistic lens, readers are invited to appreciate the complex interactions of patients, caregivers, cancer biology, health policy, politics and health human resources. Readers will find strategies to reduce the incidence, morbidity, and mortality of cancer and to improve the quality of life through the implementation of prevention, early detection, diagnosis, treatment, and supportive and palliative care in a population.

Throughout the text, examples are given of how understanding different cancer control ecosystems can improve engagement in various parts of the world.

With contributions by global experts in the field with diverse backgrounds in education, technology, public health, health policy, and advocacy, Cancer Systems and Control for Health Professionals explore diverse topics including:

• Political and economic factors that frame cancer control
• The role of data management practices in advancing cancer control efforts and reducing inequality related to gender, race, and other demographic factors
• The transformative potential of emerging technologies such as artificial intelligence and quantum computing
• The complex interplay between social determinants of health, health economics, and cancer control strategies
• The urgency of addressing structural barriers to foster health equity and position cancer care within broader socio-political contexts

Cancer Systems and Control for Health Professionals is a timely, forward-thinking resource on the subject for oncologists, cancer professionals and researchers, public health professionals and researchers, and cancer control experts, along with students in related programs of study.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Editor‐in‐Chief

Editors

Associate Editors

List of Section Editors

List of Contributors

Editors’ bios

Associate Editors

Foreword

Preface

Section 1: Cancer Systems, Services and Policy

1.1 Politics of Cancer

Political Economy of Cancer

Supra‐National Politics of Cancer

Key Issues in the Politics of Cancer Care

Future Directions

References and Recommended Reading

1.2 A Systems Approach to Cancer Care

The Organisation of Cancer Care Impacts Survival: An Example of System Factors and Cancer Care

The Need for a Systems Approach to Cancer Control

Key Issues in Cancer Care Considered as a System

Future Directions

References and Recommended Reading

1.3 Therapeutic Geographies of Cancer in Conflict Settings

Concepts and Definition

Importance to the Subject of Cancer Control

Data, Information and Research

Controversies

Challenges, Gaps and Policy Approaches

References and Recommended Reading

1.4 Quality in Cancer Care

Structural Elements

Infrastructure

Human Resources

Policies and Practices to Drive Quality

Governance and Regulatory Considerations

Conclusion

References and Recommended Reading

Section 2: The Political Economy of Cancer

2.1 Universal Health Coverage for Cancer

Costs of Universal Health Coverage

Progress Towards Universal Health Coverage

Challenges in Financing Universal Health Coverage in Cancer Care

Opportunities in Cancer Care

Priorities in Financing for Cancer Control

Conclusion

References and Recommended Readings

2.2 Health Technology Assessment and Value‐Based Care

Health Technology Assessment: An Overview

Development and Uptake of Health Technology Assessment

Gaps, Debates and Challenges

Future Directions and Opportunities

References and Recommended Readings

2.3 Equity in Access to Cancer Care

Disparities in Access Drive Disparities in Outcomes

Examining Access: Frameworks and Approaches with Applications to Cancer

Monitoring Access to Essential Cancer Care in Health Systems

Future Directions and Opportunities to Optimise Access to Cancer Care

Conclusion

References and Recommended Readings

2.4 Political Economy of Cancer in Turkey and Jordan

Progress in Cancer Control Through Investment in Health Policies and Financing in Turkey

Advancing Cancer Care in Jordan: Challenges and Opportunities

Conclusion

References and Recommended Reading

Section 3: Structure and Organisation of Cancer Services and System

3.1 Cancer Centres: A Nexus for Modern Comprehensive Cancer Care and Control

Elements of a Comprehensive Cancer Centre

Models of Cancer Centres

Cancer Network Models

Challenges

Conclusion

References and Recommended Reading

3.2 Multidisciplinary and Interprofessional Care

Importance of Multidisciplinary Care

Major Initiatives

Data and Information

Standards and Policies

Challenges and Controversies

Future Directions, Innovations and Opportunities

Impact of Virtual Care

Conclusion

References and Recommended Readings

3.3 Palliative and Supportive Care

Initiatives to Highlight Gaps in Access to Palliative Care

Challenges and Unmet Needs

Conclusion and Recommendations

References and Recommended Reading

3.4 Cancer Survivorship and Rehabilitation

Standards, Policies, Major Initiatives and Key Advances

Challenges and Unmet Needs

Global Disparity in Survivorship Services

Current Controversies

Innovation and Future Opportunities

References and Recommended Reading

3.5 Quality Improvement in Cancer Care: Principles and Application

Historical Perspective

The Science of Quality

The Practice of Quality

Global Perspectives on Quality Improvement

Opportunities

References and Recommended Reading

Section 4: Health Equity and Social Determinants of Cancer

4.1 Social Determinants and Impacts of Cancer

Burden of Disease Studies, Cancer Risk, Survival and Social Determinants

Social Determinants as Drivers of Inequalities

Strategies to Address Social Determinants and Inequalities in Cancer Care

Future Directions, Innovation and Opportunities

Conclusion

References and Recommended Reading

4.2 Cancer and Indigenous Populations

Challenges and Unmet Needs

Standardisation of the Treatment Pathway

Future Directions, Innovation, and Opportunities

Conclusions

References and Recommended Reading

4.3 Women and Cancer

Women, Health and Cancer

Burden of Cancer and Risk Factors of Cancer in Women

Examining Power and Gender Dimensions of Cancer and Cancer Care

Future Directions

Conclusion

References and Recommended Reading

4.4 Cancer in Older Adults

Current Status of Cancer Care in Older Adults

Challenges for Providing High‐Quality Care for Older Adults with Cancer

Opportunities

Conclusions and Future Directions

References

Section 5: Data and Digitally Enabled Innovation in Cancer

5.1 The Expanding Demand for Data in Cancer Control

Expanding Data Collection and Use of the Data

Challenges

Future Directions

References and Recommended Reading

5.2 Maximising and Enhancing the Value of Data in Oncology

Importance of Data in Context

Focusing on the Question Before the Data to Guide and Motivate

Culture Change Required

An Illustrative Model for a Data Management Ecosystem

Conclusion

Acknowledgements

References and Recommended Reading

5.3 Digitalisation and Cancer: Transforming, Securing and Informing Future Cancer Services

Digital Technologies Transforming the Processes of Cancer Care

Cancer Care and Vulnerability to Loss of Digital Functionality

Case for Investment and Advocacy Enabled by Digitalisation and Computation

Conclusion

References and Recommended Reading

5.4 Convergence of Digital Technologies for Cancer

Digitalisation and Consolidation of Multi‐modal Data in Oncology

Interpretable Machine Learning in Clinical Decision‐Making

Artificial Intelligence–Enabled Diagnostics: Earlier Diagnosis of Cancer

Role of Synthetic Data in Cancer Research

Digitally Enabled Acceleration of Technological Innovation in Oncology

Promise of Quantum Computing in Cancer

Future Landscape of Oncology

References and Recommended Reading

Section 6: Education

6.1 Health Literacy and Health‐Literate Organisations

Prevalence of Low Health Literacy Worldwide

Health Literacy and Health Equity

Impact of Health Literacy in Cancer Care

The Cost of Limited Health Literacy in Oncology

Health Literacy Within (Health) Organisations

Strategies to Improve Health Literacy

Planning for Health Literacy Improvements

Conclusion

References and Recommended Reading

6.2 Communication for Cancer Control

Communication Modalities

Improving the Quality of Cancer Care, Survivorship and Control Through Communication

Future Directions, Innovation and Opportunities

Conclusion

References and Recommended Reading

6.3 Health Human Resource Strategies

Challenges and Unmet Gaps

Workforce Strategies

Implementing Cancer Workforce Policies: Governance and Accountability

Future Directions, Innovation and Opportunities

References and Recommended Reading

6.4 Health Professions Education

Concepts and Definitions

Examples of Educational Initiatives from Around the World

Challenges in Health Professions Education

Opportunities and Future Directions

References and Recommended Reading

Section 7: Cancer Research

7.1 Cancer Epidemiology, Risk Factors and Prevention Research

Building an Evidence Base Across the Cancer Continuum from Prevention to Survivorship

The Cancer Burden: Heterogeneous and Evolving

Cancer Research Lifecycle

Primary Prevention of Cancer

Conclusion

Disclaimer

References and Recommended Reading

7.2 Cancer Genomics, Biomarkers and Precision Medicine

Data and Information

Emerging Technologies

Challenges and Unmet Needs

Major Controversies

Future Directions

References and Recommended Reading

7.3 Cancer Clinical Trials and Collaboratives

Data and Information

Challenges and Major Controversies

Future Directions, Innovation and Opportunities

Conclusion

References and Recommended Reading

7.4 Health Services and Outcomes Research for Cancer Control

Current Landscape

The Importance of Translating Health Service Research into Policy

Power of Collaboration in Health Service Research

Challenges and Unmet Needs

Major Controversies

Future Directions in Health Services Research

References and Recommended Reading

7.5 Achieving Seismic Change in Policy and Practice: A New Zealand Case Study

The New Zealand Cancer Control System

Inertia

The Pathway to Change

Conclusion

Acknowledgement

References and Recommended Reading

Union for International Cancer Control (UICC)

Index

End User License Agreement

List of Tables

Chapter 2_3

Table 2.3.1 Common outcomes measured for access domains.

Chapter 3_1

Table 3.1.1 Programmes and services in a cancer centre.

Table 3.1.2 Comprehensive cancer centre – definition by the Organisation of...

Chapter 3_2

Table 3.2.1 Recent studies that have demonstrated positive benefits of a mu...

Chapter 3_3

Table 3.3.1 Components of supportive care.

Table 3.3.2 Major milestones in palliative care.

Chapter 3_4

Table 3.4.1 Survivorship guidelines in initiatives.

Table 3.4.2 Notable longitudinal cohort studies and aims.

Table 3.4.3 Emerging strategies for and challenges of common late effects....

Chapter 3_5

Table 3.5.1 Comparison of common quality improvement (QI) approaches.

Chapter 4_4

Table 4.4.1 Selected institutions offering geriatric oncology training and ...

Chapter 5_1

Table 5.1.1 Examples of data collected by high‐income country population‐ba...

Chapter 5_3

Table 5.3.1 Five domains in which digital technologies are rapidly impactin...

Chapter 5_4

Table 5.4.1 Emerging technologies, applications and possible benefits in on...

Chapter 6_1

Table 6.1.1 Top health literacy practices for health professionals.

Chapter 6_2

Table 6.2.1 Modalities for digital communication.

Chapter 6_3

Table 6.3.1 Strategies for human resources to improve cancer outcomes and a...

Chapter 6_4

Table 6.4.1 Key challenges and potential opportunities/solutions for cancer...

Chapter 7_2

Table 7.2.1 Key genomics data‐sharing and interpretation initiatives.

List of Illustrations

Chapter 1_2

Figure 1.2.1 WHO health system framework.

Figure 1.2.2 Cancer care continuum.

Figure 1.2.3 Steps in planning national cancer control programmes.

Chapter 1_4

Figure 1.4.1 Conceptual model showing the health system drivers and complex ...

Chapter 2_1

Figure 2.1.1 Summary of global universal health coverage progress 2000–2019....

Chapter 2_2

Figure 2.2.1 Overview of HTA components. ELSI, ethical, legal and social imp...

Chapter 2_4

Figure 2.4.1 The political economy of cancer emphasises the overarching impa...

Chapter 3_1

Figure 3.1.1 The cancer control and cancer delivery framework.

Chapter 3_2

Figure 3.2.1 The multidisciplinary cancer team.

Chapter 3_5

Figure 3.5.1 Plan–Do–Study–Act (PDSA) cycles.

Figure 3.5.2 Architecture of quality. QI, quality improvement.

Chapter 4_1

Figure 4.1.1 Integrated conceptual framework for understanding and addressin...

Chapter 4_2

Figure 4.2.1 Factors influencing equity in cancer survival outcomes for Indi...

Chapter 4_3

Figure 4.3.1 The staircase of gender‐based inequities in cancer care.

Chapter 4_4

Figure 4.4.1 Future directions and priorities for the advancement of cancer ...

Chapter 5_2

Figure 5.2.1 An example of a data ecosystem. At MD Anderson Cancer Centre th...

Chapter 5_4

Figure 5.4.1 Convergence of digital technologies shaping the future landscap...

Chapter 6_1

Figure 6.1.1 Ten attributes of health‐literate organisations.

Chapter 6_3

Figure 6.3.1 Strengthening the cancer workforce agenda by adopting the WHO W...

Chapter 6_4

Figure 6.4.1 Key health workers/professionals across the cancer control cont...

Figure 6.4.2 CanMEDS framework diagram.

Figure 6.4.3 ASPRONET session registrations and attendance over time.

Chapter 7_1

Figure 7.1.1 Age‐standardised incidence rates of all cancers (excluding non‐...

Figure 7.1.2 Top five most common incident cancers in 2020 in men and women ...

Figure 7.1.3 Percentage change in the absolute number of new cases of cancer...

Figure 7.1.4 Population attributable fractions associated with (a) body mass...

Chapter 7_3

Figure 7.3.1 (a) Traditional two‐arm trial, patient‐level view; (b) multi‐ar...

Figure 7.3.2 Simplified collaboration set‐up for EURAMOS‐1. CDS, common data...

Chapter 7_4

Figure 7.4.1 The structure of health services research.

Figure 7.4.2 Health services research lifecycle.

Chapter 7_5

Figure 7.5.1 Key steps in achieving systems‐based change.

Figure 7.5.2 Four distinct phases of translating evidence into policy and ou...

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

Editor‐in‐Chief

List of Section Editors

List of Contributors

Editor‐in‐Chief

Foreword

Preface

Begin Reading

Union for International Cancer Control (UICC)

Index

Wiley End User License Agreement

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Cancer Systems and Control for Health Professionals

Editor‐in‐Chief

Meredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSC

Editors

Mary K. Gospodarowicz, OC, MD, FRCPC, FRCR(Hon)James D. Brierley, MBBS, FRCR, FRCP, FRCPCRichard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)

Associate Editors

Eleni Giannopoulos, BSc, MMAScZuzanna Tittenbrun, MSc, MA

Section Editors

Alejandro Berlin, MD, MScAnna Dare, MBChB, PhD, FRCSCBeverley M. Essue, MPH, PhDDanielle Rodin, MD, MPH, FRCPCDavid A. Jaffray, PhDIbrahim Abubakar, PhD, FMedSciMeredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSCRichard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)

This edition first published 2025 © 2025 UICCPublished 2025 by John Wiley & Sons, Ltd.

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The right of Meredith Giuliani, James D. Brierley, Mary K. Gospodarowicz, and Richard Sullivan to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data Applied for

Paperback ISBN: 9781394191338

Cover Design: UICC & MotherbirdCover Image: © Goodboy Picture Company/Getty Images

Editor‐in‐Chief

Meredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSCAssociate Professor, Radiation Oncology, University of TorontoDirector, Cancer Education Princess Margaret Cancer CentrePrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

Editors

Mary K. Gospodarowicz, OC, MD, FRCPC, FRCR(Hon)Professor, Radiation Oncology, University of TorontoPrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

James D. Brierley, MBBS, FRCR, FRCP, FRCPCProfessor, Radiation Oncology, University of TorontoPrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

Richard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)Professor, Cancer & Global Health at King’s College LondonDirector, King’s Institute of Cancer PolicyDirector, Centre for Conflict & Health ResearchKing's College LondonLondon, United Kingdom

Associate Editors

Eleni Giannopoulos, BSc, MMAScResearch Associate, Cancer Education Princess Margaret Cancer CentreUniversity Health NetworkToronto, Canada

Zuzanna Tittenbrun, MSc, MAGlobal Resources Manager, Knowledge, Advocacy and PolicyUnion for International Cancer ControlGeneva, Switzerland

List of Section Editors

Section 1

Richard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)Professor, Cancer & Global Health at King’s College LondonDirector, King’s Institute of Cancer PolicyDirector, Centre for Conflict & Health ResearchKing's College LondonLondon, United Kingdom

Section 2

Beverley M. Essue, MPH, PhDAssociate Professor, Global Health SystemsInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoToronto, Canada

Richard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)Professor, Cancer & Global Health at King’s College LondonDirector, King’s Institute of Cancer PolicyDirector, Centre for Conflict & Health ResearchKing's College LondonLondon, United Kingdom

Section 3

Meredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSCAssociate Professor, Radiation Oncology, University of TorontoDirector, Cancer Education Princess Margaret Cancer CentrePrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

Section 4

Beverley M. Essue, MPH, PhDAssociate Professor, Global Health SystemsInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoToronto, Canada

Ibrahim Abubakar, PhD, FMedSciProfessor of Infectious Disease EpidemiologyPro‐Provost (Health) and Dean, Faculty of Population Health SciencesUniversity College LondonLondon, United Kingdom

Section 5

David A. Jaffray, PhDProfessor, Departments of Radiation Physics and Imaging PhysicsDirector, Institute for Data Science in OncologySenior Vice President and Chief Technology and Digital Officer,The University of Texas MD Anderson Cancer CenterHouston, TX, United States

Alejandro Berlin, MD, MScAssociate Professor, Radiation Oncology, University of TorontoPrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

Section 6

Meredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSCAssociate Professor, Radiation Oncology, University of TorontoDirector, Cancer Education Princess Margaret Cancer CentrePrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

Section 7

Anna Dare, MBChB, PhD, FRCSCAssistant Professor, Department of Surgery, University of TorontoDivision of General Surgery and Li Ka Shing Knowledge Institute, St. Michael’s Hospital TorontoToronto, Canada

Danielle Rodin, MD, MPH, FRCPCAssociate Professor, Radiation Oncology, University of TorontoPrincess Margaret Cancer Centre, University Health NetworkToronto, Canada

List of Contributors

Omar Abdihamid, MD, MMed, MPHGarissa Regional Cancer CenterGarissa County Referral HospitalGarissa, Kenya

Ibrahim Abubakar, PhD, FMedSciUniversity College LondonLondon, UK

Ajay Aggarwal, MD, MRCP, FRCR, PhDFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineGuy’s & St Thomas’ NHS TrustLondon, UK

Jacqueline Alcalde, MD, MMedSciDepartment of Supportive CarePrincess Margaret Cancer Centre, University Health NetworkToronto, CanadaDivision of Palliative Medicine, Department of MedicineUniversity of TorontoToronto, Canada

Haimanot Kasahun Alemu, MDSt. Paul’s Hospital Millennium Medical College (HKA)Addis Ababa, Ethiopia

Zipporah Ali, MD, MPH, MPCKenya Hospices and Palliative Care AssociationNairobi, Kenya

Waleed Alrjoub, BScKing Hussein Cancer CenterAmman, Jordan

Alejandro Berlin, MD, MScRadiation Medicine Program, Princess Margaret Cancer CentreUniversity of TorontoToronto, Canada

Nickhill Bhakta, MD, MPHDepartment of Global Pediatric MedicineSt. Jude Children’s Research HospitalMemphis, TN, USA

Josep Maria Borras, MD, PhDDepartment of Clinical Sciences, IDIBELLUniversity of BarcelonaCatalan Cancer Plan, Department of HealthBarcelona, Spain

Freddie Bray, PhDInternational Agency for Research on CancerLyon, France

James Brierley, MBBS, FRCR, FRCP, FRCPCDepartment of Radiation Oncology, Princess Margaret Cancer CentreUniversity of TorontoToronto, Canada

Jiaoyang Cai, MD, PhDDepartment of Hematology/Oncology, Shanghai Children’s Medical CenterShanghai Jiao Tong University School of MedicineNational Children’s Medical CenterShanghai, China

Maritza Carvalho, RN, BN, MHSc, CON(C)Princess Margaret Cancer CentreUniversity Health NetworkToronto, Canada

Otuto Amarauche Chukwu, MPharm, BPharmInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoToronto, Canada

Caroline Chung, MD, MSc, FRCPC, CIPDivisions of Radiation Oncology and Diagnostic ImagingUT MD Anderson Cancer CenterHouston, TX, USA

Anna J. Dare, MBChB, PhD, FRCSCDepartment of SurgeryUniversity of TorontoDivision of General SurgerySt. Michael’s HospitalToronto, Canada

Avram Denburg, MD, MSc, PhD, FRCPCDivision of Haematology/OncologyThe Hospital for Sick ChildrenInstitute for Health Policy, Management and EvaluationUniversity of TorontoToronto, Canada

Omar Dewachi, MD, PhD, MPHDepartment of AnthropologyRutgers UniversityNew Brunswick, NJ, USA

Andrew Dimech, RN, BN, MSc ICU, Dip Onc.Peter MacCallum Cancer CentreUniversity of MelbourneMelbourne, Australia

Zodwa Dlamini, PhDSAMRC Precision Oncology Research Unit (PORU), Pan African Cancer ResearchInstitute (PACRI)University of PretoriaPretoria, South Africa

Jesper Grau Eriksen, MD, PhDDepartment of Experimental Clinical OncologyAarhus University HospitalAarhus, Denmark

Josep Alfons Espinas, MD, PhDDepartment of Clinical Sciences, IDIBELLUniversity of BarcelonaCatalan Cancer Plan, Department of HealthBarcelona, Spain

Beverley M. Essue, MPH, PhDInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoToronto, Canada

Gail Garvey (Kamilaroi Nation), BEd, MEd, PhDSchool of Public HealthUniversity of QueenslandBrisbane, Australia

Adrian Gheorghe, PhDComprehensive Cancer CentreKing’s College LondonLondon, UKCenter for Global DevelopmentWashington, DC, USA

Arunangshu Ghoshal, MD, MResDepartment of Supportive Care, Princess Margaret Cancer CentreUniversity Health Network, Toronto, CanadaDivision of Palliative Medicine, Department of MedicineUniversity of TorontoToronto, CanadaDepartment of Palliative Medicine and Supportive CareKasturba Medical College and Hospital, Manipal Academy of Higher EducationManipal, India

Eleni Giannopoulos, BSc, MMAScPrincess Margaret Cancer CentreUniversity Health NetworkToronto, Canada

Duncan C. Gilbert, MRCP, FRCR, PhDMRC Clinical Trials Unit, Institute of Clinical Trials and MethodologyUniversity College LondonLondon, UKSussex Cancer Centre, Royal Sussex County HospitalUniversity Hospitals Sussex NHS Foundation TrustBrighton, UK

Meredith Giuliani, MBBS, MEd, PhD, FRCPC, DRCPSCDepartment of Radiation OncologyUniversity of TorontoPrincess Margaret Cancer CenterToronto, Canada

Daniel W. Golden, MD, MHPEDepartment of Radiation OncologyRush University Medical CenterChicago, IL, USA

Carolina Gómez‐Moreno, MD, MScInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City, Mexico

Mary Gospodarowicz, OC, MD, FRCPC, FRCR(Hon)Department of Radiation OncologyPrincess Margaret Cancer CentreUniversity Health NetworkToronto, Canada

Jason Gurney (Ngāpuhi), BSc(Hons), PhDDepartment of Public HealthUniversity of OtagoWellington, New Zealand

Nazik Hammad, MD, FRCPC, MSc, MEHP, FACPDivision of Hematology‐Oncology,St Michael’s HospitalUniversity of TorontoToronto, Canada

Breffni Hannon, MB BCh BAO, MMedSciDepartment of Supportive Care, Princess Margaret Cancer CentreUniversity Health Network, Toronto, CanadaDivision of Palliative Medicine, Department of MedicineUniversity of TorontoToronto, Canada

Rodney Haring (Seneca Nation), PhD, MSWRoswell Park Comprehensive Cancer CenterNew York, USA

Ewen M. Harrison, OBE, MB, ChB, MSc, PhD, FRCS, FRSE, FMedSciCentre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburgh, UK

Melissa M. Hudson, MDDepartment of OncologySt. Jude Children’s Research HospitalMemphis, TN, USA

Wanrudee Isaranuwatchai, PhD, BScInstitute for Health Policy, Management and EvaluationUniversity of TorontoToronto, CanadaHealth Intervention and Technology Assessment Program (HITAP)Ministry of Public HealthNonthaburi, Thailand

Christopher G.C.A. Jackson, MBChB, FRACPDepartment of Medicine, Otago Medical SchoolUniversity of OtagoDunedin, New Zealand

David A. Jaffray, PhDDepartments of Radiation Physics and Imaging PhysicsUT MD Anderson Cancer CenterHouston, TX, USA

Rana Jin, RN, DNP, CON(C)Princess Margaret Cancer CentreUniversity Health NetworkToronto, Canada

Jennifer M. Jones, PhDDepartment of Psychiatry, Dalla Lana School of Public HealthUniversity of TorontoPrincess Margaret Cancer CentreToronto, Canada

Anet Julius, RN, BScN, MN, CON(C)Princess Margaret Cancer CentreUniversity Health NetworkLawrence S. Bloomberg Faculty of NursingUniversity of TorontoToronto Centre South Regional Cancer Program, Ontario HealthToronto, Canada

Gabrielle Kane, MB, BCh, EdD, FRCPC, FSACMEDepartment of Radiation OncologyUniversity of WashingtonSeattle, WA, USA

Felicia M. Knaul, PhDSylvester Comprehensive Cancer CenterInstitute for Advanced Study of the AmericasDepartment of Public Health Sciences and Leonard M. Miller School of MedicineUniversity of MiamiCoral Gables, FL, USAandTómatelo a Pecho ACMexico City, MexicoandFaculty of ExcellenceTecnológico de MonterreyMonterrey, Mexico

Stephen Knight, MBChB (Hons), PhD, FRCS(Ed)Center for Medical Informatics, Usher InstituteUniversity of EdinburghEdinburgh, UKSchool of Health and WellbeingUniversity of GlasgowGlasgow, UK

Jonathan Koea (Ngāti Mutunga, Ngāti Tama), MD, MHB (Hons), MBChBHealth NZ – WaitematāUniversity of AucklandAucklandNew Zealand

Urska Kosir, DPhil (PhD)Department of Experimental PsychologyUniversity of OxfordOxford, UK

Monika K. Krzyzanowska, MD, MPH, FRCPC, FASCOCancer Quality Lab (CQuaL)Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreInstitute of Health Policy, Management and EvaluationUniversity of TorontoOdette Cancer Centre, Sunnybrook Health Sciences CentreToronto, Canada

Tezer Kutluk, MD, PhDFaculty of Medicine and Cancer InstituteHacettepe UniversityAnkara, Turkey

Aidan Leong, MHealSc, BHealSc(Hons)Department of Radiation TherapyUniversity of OtagoBowen Icon Cancer CentreWellington, New Zealand

Erica Liebermann, PhD, ANP, WHNPCollege of NursingUniversity of Rhode IslandProvidence, RI, USA

Aisha Lofters, MD, PhDDepartment of Family & Community MedicineUniversity of TorontoPeter Gilgan Centre for Women’s CancersWomen’s College HospitalToronto, Canada

Sharon B. Love, BSc (Hons)MRC Clinical Trials Unit, Institute of Clinical Trials and MethodologyUniversity College LondonLondon, UK

Asem Mansour, MDKing Hussein Cancer CenterAmman, Jordan

Alicia Martin, BPhysio, MPhysio, GAICDPeter MacCallum Cancer CentreUniversity of MelbourneMelbourne, Australia

Michele Matta, PhDInternational Agency for Research on CancerLyon, France

Valerie McCormack, PhDInternational Agency for Research on CancerLyon, France

Megan McLeod, MD, MScDepartment of Otolaryngology – Head and Neck SurgeryVanderbilt University Medical CenterNashville, TN, USA

Angela M. Meade, DPhil, MSc, BSc(Hons)MRC Clinical Trials Unit, Institute of Clinical Trials and MethodologyUniversity College LondonLondon, UK

Olivier Morin, PhDDepartments of Medical Physics and Radiation OncologyUniversity of California San FranciscoSan Francisco, CA, USA

Miriam Mutebi, MD, MSc, FACSDepartment of SurgeryAga Khan University HospitalNairobi, Kenya

Leslie E. Oldfield, MScSchool of Medicine & DentistryGriffith University, Gold CoastSouthport, Australia

Brian O’Sullivan, MB, FRCPC, FRCPI, FFRRCSI (Hon)Department of Radiation Oncology, Princess Margaret Cancer CentreUniversity of TorontoToronto, CanadaDepartment of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM)University of MontréalMontreal, Canada

Janet Papadakos, PhD, MEdCancer Health Literacy Research Centre, Cancer EducationPrincess Margaret Cancer CentreThe Institute for Education ResearchUniversity Health NetworkInstitute for Health Policy, Management & EvaluationUniversity of TorontoToronto, Canada

Melanie Powis, PhDCancer Quality Lab (CQuaL)Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreInstitute of Health Policy, Management and EvaluationUniversity of TorontoToronto, Canada

Joan Prades, PhD, MPHDepartment of Clinical Sciences, IDIBELLUniversity of BarcelonaCatalan Cancer Plan, Department of HealthBarcelona, Spain

C.S. Pramesh, MDDepartments of Surgical Oncology and AdministrationTata Memorial Centre, Homi Bhabha National Institute, Mumbai, IndiaandNational Cancer GridMumbai, India

Trevor J. Pugh, PhD, FACMGPrincess Margaret Cancer Centre, University Health NetworkOntario Institute for Cancer ResearchDepartment of Medical Biophysics, University of TorontoToronto, Canada

Priya Ranganathan, MDDepartment of Anaesthesiology, Critical Care and PainTata Memorial CentreHomi Bhabha National InstituteNational Cancer GridMumbai, India

Danielle Rodin, MD, MPH, FRCPCDepartment of Radiation OncologyUniversity of TorontoRadiation Medicine ProgramPrincess Margaret Cancer CentreToronto, Canada

Ambreen Sayani, MD, MSc, PhDInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoDepartment of Family & Community MedicineUniversity of TorontoToronto, Canada

Joachim Schüz, PhDInternational Agency for Research on CancerLyon, France

Omar Shamieh, MD, MBAKing Hussein Cancer CenterAmman, Jordan

Mac Skelton, PhDInstitute of Regional & International StudiesAmerican University of Iraq‐SulaimaniSulaymaniyah, IraqGlobal Oncology GroupKing’s College LondonLondon, UK

Isabelle Soerjomataram, PhDInternational Agency for Research on CancerLyon, France

Enrique Soto‐Perez‐de‐Celis, MD, PhDDivision of Medical OncologyUniversity of Colorado Anschutz Medical CampusAurora, Colorado, USA

Richard Sullivan, BSc, MBBS, FRCS, PhD, FFPM(Hon)Institute of Cancer PolicyKing’s College LondonLondon, UK

Matthew R. Sydes, BSc, MScMRC Clinical Trials Unit, Institute of Clinical Trials and MethodologyUniversity College LondonBHF Data Science Centre, Health Data Research UKLondon, UK

Dario Trapani, MDDivision of Early Drug Development, European Institute of Oncology (IEO)Scientific Institute for Research, Hospitalization and Healthcare (IRCCS)Department of Oncology and Hematology (DIPO)University of MilanMilan, Italy

Sandra Turner, MBBS(Hons), PhD, FRANZCRFaculty of Medicine and HealthUniversity of SydneyWestern Sydney Radiation Oncology NetworkSydney, Australia

Verna Vanderpuye, MB ChB, FWACS, FGCPNational Center for RadiotherapyKorle Bu Teaching HospitalAccra, Ghana

Haydeé Verduzco‐Aguirre, MD, MScInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City, Mexico

David Wiljer, PhDEducation Technology InnovationUniversity Health NetworkDepartment of Psychiatry, Institute of Health Policy, Management & EvaluationUniversity of TorontoThe Wilson CentreToronto, Canada

Camilla Zimmermann, MD, MPH, PhD, FRCPCDepartment of Supportive Care, Princess Margaret Cancer CentreUniversity Health NetworkDivision of Palliative Medicine, Department of MedicineUniversity of TorontoToronto, Canada

Editors’ bios

Meredith GiulianiMeredith Giuliani MBBS, MEd, PhD, FRCPC, DRCPSC is an Associate Professor in the Department of Radiation Oncology at the University of Toronto, the Director of Education at Princess Margaret Cancer Centre and the Associate Dean of Postgraduate Medical Education at the University of Toronto. Dr. Giuliani received her MBBS qualification from the University of London and she then competed her residency training in radiation oncology at the University of Toronto. She received her Master’s of Education from the Ontario Institute of Sciences in Education at the University of Toronto and her PhD from the School of Health Professions Education at Maastricht University. Her PhD focused on globalisation and the influence of neocolonialism on curricula. She has an active education research lab that focuses on globalisation, the influence of education on health systems and the intersection of education and health disparities.

Mary GospodarowiczMary Gospodarowicz, Professor of Radiation Oncology and University Professor at the University of Toronto, is a former director of the Princess Margaret Cancer Centre in Toronto and a former Regional Vice‐President of Cancer Care Ontario. She is currently interested in global cancer control, global access to radiotherapy and quality cancer care. Her prior work focused on clinical trials evaluating radiation therapy in lymphomas and genito‐urinary malignancies, image‐guided precision radiotherapy, cancer staging and prognosis and cancer survivorship. Beyond global cancer control she is engaged in mentorship and leadership development. She is a past President of the Union for International Cancer Control (UICC). She co‐chairs the Lancet Commission on Cancer and Health Systems and the Lancet Oncology Commission on Cancer in the Commonwealth. She is an Honorary Fellow of the Royal College of Radiologists in the United Kingdom and an Officer of the Order of Canada.

James BrierleyJames D. Brierley BSc, MB, FRCP, FRCR, FRCPC is Emeritus Professor of the Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto. Dr. Brierley trained in clinical oncology in the United Kingdom and developed his interest in cancer staging and surveillance when moving to Canada; he has been involved in cancer surveillance locally, nationally and internationally. He is Co‐Chair of the UICC TNM Prognostic Factors Project. He co‐edited the TNM Classification of Malignant Tumours, 8th ed. (Wiley 2017) and is currently working on the 9th edition. In addition, he was co‐editor of the TNM Supplement 5th ed. (Wiley 2019), UICC Manual of Clinical Oncology (Wiley 2015) and UICC TNM Atlas, 7th ed. (Wiley 2020).

Richard SullivanRichard Sullivan is Professor, Cancer & Global Health at King’s College London. He is Director of the Institute of Cancer Policy and the Centre for Conflict & Health Research, an NCD advisor to the World Health Organization (WHO), Senior Fellow of the Centre for Global Development and the United Kingdom’s representative to the WHO IARC Scientific Governing Council. Professor Sullivan’s global cancer research programmes cover cancer systems strengthening, political economy, pharmaceutical policy and global cancer surgery, with a special interest in cancer care in conflict. He has several major research programmes in conflict and health with a special focus on the Middle East and Sub‐Saharan African regions, specifically in health security intelligence and health systems strengthening in conflict. He trained in surgical oncology with a PhD in Biochemistry from University College London. Professor Sullivan has published over 500 articles, including 17 Lancet & Lancet Oncology Commissions. He was previously Clinical Director of Cancer Research UK and is a past Director of the Council for Emerging National Security Affairs.

Associate Editors

Eleni GiannopoulosEleni Giannopoulos, BSc, MMASc, is a Research Associate at the Princess Margaret Cancer Centre in Toronto, Canada. She received her Honours Bachelor of Science degree in Cell and Molecular Biology from the University of Toronto, and obtained a Master of Management of Applied Science degree from Western University. Her research interests in the Cancer Health Literacy Research Centre primarily include: health literacy and self‐management behaviours, exploring the application and use of cancer patient‐reported experience measures, and evaluating cancer patient education materials.

Zuzanna TittenbrunZuzanna Tittenbrun, MSc, MA, is a Global Resources Manager at the Knowledge, Advocacy and Policy team of the Union for International Cancer Control (UICC). She works in the area of cancer staging managing UICC’s flagship Tumour, Node, Metastases Project that publishes UICC TNM Classification of Malignant Tumours. She also works in cancer control planning, managing a web portal of the International Cancer Control Partnership (ICCP) which serves as a repository of publicly available national cancer control plans. Before joining UICC, Zuzanna worked for the Nobel Peace Prize laureate International Campaign to Ban Landmines – Cluster Munitions Coalition coordinating civil society’s presence in the humanitarian disarmament arena. She holds a Master of Arts in Cultural Studies and Foreign Languages and a Master of Science in Global Health Policy at The London School of Hygiene & Tropical Medicine.

Foreword

The ambition of the project that is this book is matched only by the degree of success in the breadth of its scope and the excellence of the presentation. Cancer Systems and Control for Health Professionals sets out to address this Herculean task through the development of seven sections containing 30 chapters by a set of international experts. The simplicity of the title belies the complexity of the problem, which is dissected not only by focusing on cancer as a disease but also by demonstrating with clarity that it represents a perturbation that is both biological as well as social. It places cancer, as so many of the authors state, within an ecosystem that must take account of the political economy of societies and even ventures to address that economy as not only national in scope. Readers will welcome the centrality of equity as an overriding principle in cancer control; it is refreshing to see the reference point for the inequality that results in inequity running the gamut from the social situation through gender and race among other factors.

One of the strong points of the book is that some of the presentations lead the reader to be optimistic about the possibility of a ‘brave new world’ in which appropriate data and its transformation through new technologies into information will be so omnipresent that they will reduce some of the inequities that now exist in cancer control. Of course, the possibility is not denied that because of their sophistication these new technologies will accentuate the problem for people and communities less well‐endowed for reasons beyond their control.

It would not have been surprising had this book outlined the magnitude of the problem and established the basis for advocacy but not pointed towards possible advocates. Yet the book is clear that there is a role for a wide range of health professionals and, dare I add, other people with an interest in health to be advocates for the propositions it outlines. It evokes the aptness of Rudolf Virchow's famous claim that doctors are the natural advocates for the problems of the poor and disadvantaged. I was also pleased to see that the book does not entertain the false dichotomy of the individual versus the population‐based approach. It articulates clearly the imperative of specialised cancer care centres as well as interventions at the population level.

I recommend this book highly as a fascinating exposition of the many and varied facets of cancer control and the different aspects of the systems that must be explored for improvement on the status quo.

Sir George Alleyne

May 2024

Preface

Cancer, a pervasive global health challenge, affects millions of people worldwide, yet access to comprehensive cancer care remains unequal on a global scale. Addressing cancer's multifaceted nature necessitates a systems approach to this very complex set of diseases. In addition to an interdisciplinary approach that integrates insights from all disciplines of medicine, it also needs input from diverse fields such as education, technology, public health, health policy and advocacy. Cancer care is delivered within a comprehensive ecosystem that should be understood by those working within a health system as well as by those who are the recipients of health interventions.

This book, Cancer Systems and Control for Health Professionals, is a scholarly endeavour to bridge the disciplinary divides inherent in cancer care and to serve as a definitive resource for both clinicians and researchers. Its distinguishing feature lies in its systematic exploration of cancer through a holistic lens, emphasizing systems‐level understanding and the application of cancer control theory principles to address its complexities.

Central to this book is an exploration of the intricate interplay between social determinants of health, health economics and cancer control strategies. The authors underscore the urgency of addressing structural barriers to foster health equity, positioning cancer care within broader sociopolitical contexts. Moreover, the critical role of data management practices in advancing cancer control efforts is explored, alongside the transformative potential of emerging technologies such as artificial intelligence and quantum computing. Education is presented as a cornerstone in the advancement of cancer care, nurturing a cadre of healthcare professionals equipped with the requisite knowledge and skills to navigate the intricate landscape of oncology effectively.

Through the lens of systems thinking, readers are invited to appreciate the complex interactions of patients, caregivers, cancer biology, health policy and health human resources. Cancer Systems and Control for Health Professionals represents a needed contribution to the field, offering a unique comprehensive synthesis of knowledge across disciplines and illuminating novel avenues for cancer control. It is our collective aspiration that this book will serve as a guide to improve cancer control globally.

Meredith Giuliani

Section 1Cancer Systems, Services and Policy

Richard Sullivan

Institute of Cancer Policy, King's College London, London, UK

The political scientist John Kingdom saw the need to move beyond technocentric approaches of policymaking into a more process‐oriented discourse centred on policy, politics and problem sets. This section seeks to highlight some of the critical contemporary domains framed in this manner within global cancer.

Sullivan and Pramesh begin by exploring the political dimensions of global cancer, particularly through a political economy lens. In seeking to understand how cancer services and systems operate, they examine the nature of power as part of a wider political discourse. Unpicking these dimensions means examining the nature of power and politics not just at the national level but also in terms of supra‐national actors that influence and affect global cancer. By bringing in the economic perspective, the politics of cancer can be analysed and understood through the macroeconomic lens of allocation and distribution.

In framing global cancer as a complex adaptive systems problem, Borras, Prades and Espinas dissect out the system‐level thinking that is required for national and supra‐national policy to adequately reflect and address the myriad of contemporary issues. They challenge the purely technical approach to cancer policy by injecting the importance of systems analysis – actor‐network, emergence – into core policy pillars such as leadership and governance. Systems‐level policy analysis provides a deeper and more robust conceptual basis to understand cancer's hierarchical interactions, dynamic changes and self‐organisation in the face of external stresses.

Skelton and Dewachi take the idea of systems further by fundamentally challenging how we understand traditional cancer services and systems through normative hierarchical referral within national boundaries. They illuminate how many patients now use novel therapeutic geographies, often across national borders, to seek care, especially those impacted by conflict. These realities challenge the domination of traditional epidemiology and demography to adequately describe the cancer landscape. Instead, they talk to the need for deeper social science methodologies, particularly applied anthropology in policy research.

Finally, McLeod and Aggarwal tackle one of the most important pillars in the cancer policy systems landscape – quality – through a critical Donabedian lens. Their discourse provides a wide vista on the most significant policy issues and tools facing national cancer planning to deliver high‐quality services, from choice and competition through to the application of health technology assessments. These interlocking issues and tools also illuminate the policy dimensions of the structural determinants of quality in cancer, for example human resources.

Overall, the section provides a multi‐layered exploration of the critical issues in contemporary global cancer policy, but inevitably leaves out some key domains that the reader can and should explore, for example cancer within the context of development, the wide‐ranging issues of governance and legislation, as well as the specificities of individual countries and regions.

1.1Politics of Cancer

Richard Sullivan1 and C.S. Pramesh2

1 Institute of Cancer Policy, King's College London, London, UK

2 Departments of Surgical Oncology and Administration, Tata Memorial Centre, Homi Bhabha National Institute & National Cancer Grid, Mumbai, India

Key Facts

Politics plays a critical role in health policy and healthcare systems globally, and the political environment that determines the state of health systems is a continuous struggle between competing interests.

Cancer, by virtue of its complexity, cost and the need for significant management of service structure and organisation, reflects the strengths and weaknesses of health and political systems.

Political determinants of cancer control are important not just through the philosophical lens of social justice, but also because of their intricate links to the practical aspects of the outcomes of patients diagnosed with cancer.

All aspects of cancer control, including care, access and affordability, human resources and research, are impacted by politics at local, regional, national and supra‐national levels.

Recognition of the fact that social, cultural, fiscal and political elements are as important as the medical (technical) aspects in cancer control is critical for oncology professionals globally.

Health services and systems are political choices. The political environment that determines the state of healthcare is a constant struggle for power and prioritisation among competing interests. Failure to recognise this important truth often results in tension between public health professionals, who believe that health and healthcare policy should be dictated by evidence and data‐driven decisions, and policy‐makers, who believe that social, fiscal and political aspects need to be considered as well. It is paradoxical that while this truth is widely accepted, there is an absence of open discussion and acknowledgement of the related facts. Bambra and colleagues argue that health is inherently political because of three reasons: first, there is inequity on socioeconomic grounds like any other commodity; second, because its social determinants are often influenced by political action (or inaction), and finally, because the ‘right to health’ is an aspect of citizenship and should be a basic human right. As an apex disease in terms of complexity, cost and the need for significant management of service structure and organisation, cancer reflects all the strengths and weaknesses of health and political systems. Reimagining cancer through the viewpoint of political determinants should include analysing how outcomes are affected by different power constellations, organisations, systems and processes, interests (often vested) and ideological positions (often biased) across a range of diverse political systems and cultures and different levels of governance.

Why are political determinants so important? Philosophically, it is a matter of social justice. High‐quality, affordable and equitable cancer care is not evenly distributed between or even within countries. Foundational aspects of human rights and health are predetermined by political actions; they do not spontaneously arise from society. Practically, outcomes for patients diagnosed with cancer are determined not just by access to and availability of high‐quality care, but by the social determinants of health – economics, ethnicity, geopolitical situation and so on – that determine whether or not patients get good care. The socioeconomic ecosystems of countries – including employment, culture and education – are determined to a large extent by political actions.

Politics ultimately shapes cancer through factors such as ‘the distribution of money, power and resources at global, national, regional and local levels’ (BMJ 2015;350:h81) – all of which can only be tackled by political action in sectors beyond health. Cancer education, training, care and research are mainly shaped by national politics. These determine the state of the social determinants of cancer, the degree to which patients are financially protected through a diagnosis of cancer, the availability and quality of the myriad of services needed for care, and even whether, for patients with terminal disease, they have a ‘good death’. National politics is about allocation of (scarce) resources to health and cancer control and thus is ultimately about prioritisation, be this for training, prevention, care or research. The politics of health and cancer is prosecuted through a multiplicity of different governmental systems. There are about 29 different governmental systems ranging from military dictatorships through to theocracies. The way politics shapes health and cancer at national levels changes rapidly in time and space. Stable, democratic, highly socialised/solidarity political systems are the exception, not the norm. In many countries, the average time in position for ministers and civil servants tasked with health and cancer control is less than six months.

Beyond national systems, cancer is shaped by a wide range of direct and indirect political actors and forces. While governments have a key role in cancer prevention, a great deal of national public health, including pro‐cancer risk factors such as tobacco, saturated fats and so on, is determined by international political agreements around trade and commerce. Such political choices often trump public health strategy, especially in countries with weak political and economic systems, thus exposing their populations to a wide range of cancer risk factors. On the other hand, supra‐national agreements can also protect countries, for example the World Health Organization (WHO) Framework Convention on Tobacco Control and different legislation around the safe use of nuclear medicine including radiotherapy. These agreements are politically enabled at the supra‐national level. Trans‐national politics also determines the degree to which individual or collective countries seek to support cancer care, training or research in those countries with the most need. Often driven by national interest, such political determinants can have powerful influences on the state of cancer in specific countries.

Today, major initiatives such as the USA's Cancer Moonshot 2 programme focus political attention and fund cancer workforce issues across sub‐Saharan Africa, Latin America and the Caribbean. China's Belt and Road Initiative is also deepening its bilateral political relationships around cancer in sub‐Saharan Africa, particularly through infrastructure support, such as new cancer hospitals. The politics of cancer finds agency too through three major United Nations (UN) organisations: the International Atomic Energy Agency's (IAEA) Programme of Action for Cancer Therapy (PACT) and the more recent Rays of Hope initiative, the WHO and its regional bodies and the WHO's International Agency for Research on Cancer. These organisations hold critical power through member states' political direction in establishing normative frameworks, convening and operational deliverables, often in partnership. In addition, there is a range of non‐UN organisations, including the Union for International Cancer Control (UICC), the City Cancer Challenge (C/Can), the WHO/St Jude Global Initiative on Childhood Cancer (GICC) and the Clinton Health Access Initiative (CHAI), as well as ad hoc political groupings including the G7 that work on different political dimensions of global cancer.

Political Economy of Cancer

Societies and their cancer services are complex and dynamic systems shaped by their historical contingencies as well as their contemporary economics, production and consumption activities, power relations, governance, policies, polities (or institutions), legal rules, culture, values and ecology. The political economy of cancer determines the interrelationships and power dynamics linking political decisions through economics to changes in cancer control and policy. A political economy view of cancer essentially seeks to understand how specific policies are implemented in different places and times.

While there have been numerous studies of general health and political economy, especially around how economic growth and development reduce mortality rates, the application of political economy to cancer has been relatively recent. The multidisciplinary methods used in political economy analysis help us understand which aspects of political and economic choices are important for a given context and time in improving care, education, research and outcomes. This approach enables one to dissect out, in a critical manner, the relative contributions of technologies and changes to the structure and organisation of cancer care. Using this analytical lens, one can assess the relative economic choices in terms of overall gross domestic product (GDP) and cancer as a part of universal health coverage. The political economy approach also enables a more balanced analysis of the relative priorities of political systems.

The political economy of the welfare state in a country has major impacts on cancer outcomes. The politics of economic recession, income and wealth inequality, the type of welfare state, employment policy, urban regeneration, housing, healthcare policy and trade impact the patient pathway to diagnosis and the subsequent journey through care. In industrialised countries, for example, a 1% increase in unemployment increases age‐standardised mortality for cancer by over 2%. Seen through the lens of political economy, while the COVID‐19 pandemic had significant direct impacts on cancer‐related mortality, by far the greatest systemic shock to cancer outcomes was due to a reduction in access to and availability of care as well as the penumbral impacts of economic downturns due to both national and international political decisions. The combination of austerity policies and other impacts of recession in some countries with minimal welfare state provision further exacerbates the negative health impacts on cancer outcomes. Moreover, the pursuit of more neoliberal approaches to economic policy for welfare and health in high‐income countries results in worsening health inequalities and higher cancer mortality rates.

Key Aspects of the Political Economy of Cancer

This is a critical domain for the social determinants of cancer spanning welfare state approaches, economic policy, public spending, health and education provision and housing provision and policy. All of these have compounding impacts on patient pathways for cancer.

The political economy describes how elites utilise economic power to further political agendas. In some cases this may be for the benefit of patients with cancer, but in many countries, elite power ensures that these affluent populations seek care abroad. With little political capital, there is no reason for these elites to invest in effective domestic national cancer control plans.

The ability to deliver effective, affordable and equitable national cancer control plans is predicated on foundational political economic decisions. This requires at least 5% of GDP to be spent on public healthcare and more than 80% of the population should be covered by basic universal health coverage (UHC). However, as of 2023, the World Bank Global Monitoring Report tracking UHC found that 108 out of 194 countries have the same pattern of stagnating service coverage and worsening financial hardship as they did in 2015.

Framing of prioritisation actions for the delivery of cancer technologies and services, for example the construction of and legislation around health technology assessment programmes, is a key part of the political economy of cancer. Such decision frameworks indicate what willingness‐to‐pay thresholds political entities set for cancer technologies and the way these economic trade‐off decisions are made.

The political economy frames how governments regulate new cancer technologies, especially systemic cancer treatments. International political actions around this, for example Project Orbis, shape how markets for biopharmaceuticals, and more widely medtech including artificial intelligence (AI), impact issues of affordability in cancer care.

Supra‐National Politics of Cancer

At the supra‐national level, cancer politics operates through a nested multi‐scale, complex adaptive system. Since the emergence of the Sustainable Development Goals, the supra‐national cancer agenda has been shaped by a series of critical political junctures. Overall, there have been nine non‐communicable disease (NCD) targets for 2025/2030. Cancer is subsumed into a generic NCD target – 25% relative reduction in the risk of premature (NCD) mortality. In 2017, the World Health Assembly passed the resolution ‘Cancer prevention and control in the context of an integrated approach’ (WHA70.12) that set the political targets specified in the Global Action Plan for the prevention and control of NCDs 2013–2020 and the 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer. Since then the political dialogue has coalesced around a number of major initiatives: the Global Strategy for cervical cancer elimination, Global Breast Cancer Initiative and Global Initiative for Childhood Cancer. In addition, the IAEA has launched a political platform – Rays of Hope – to focus attention and funding on building radiotherapy capacity and capability. Much of this political work by UN agencies has, in addition to working directly with member states, focused on engagement with multilateral development banks (MDBs) including the World Bank Group. However, this has been a heavily contested political space, with major calls on MDBs to support climate action, pandemic preparedness (health system resilience) and more transversal health programmes.

Other major political supra‐national areas have focused on the critical issue of workforce. While the Recife Political Declaration on Human Resources for Health was supposed to set in place rules to avoid countries asset stripping the key health (and cancer) workforce, the inability to create a tangible political framework has meant that high‐income countries have had little incentive not to ‘headhunt’ the cancer workforce from weaker, lower‐resource countries. The resulting ‘brain drain’ has had a substantial adverse impact on health systems in low‐ to middle‐income countries. The political ramifications have led to renewed calls for high‐income countries to address this cancer workforce imbalance, for example through the USA's reignited Cancer Moonshot 2 initiative.

Bilateral and multilateral political actions around cancer have been driven by specific interest groups. For example, childhood cancer remains one of the most important and dynamic global political platforms. While St. Jude Children's Research Hospital and the WHO have politically engaged in the Global Initiative on Childhood Cancer, many organisations – including World Child Cancer and the International Society of Pediatric Oncology (SIOP) – have created strong political spaces for shaping research and care. In the adult space, political actions have been driven by professional organisations, particularly those with substantive funding from the biopharmaceutical sector, such as the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO).

Regional political initiatives to support cancer research, for instance the European Union's Cancer Mission, tap into wider representational networks that bring together domain‐specific political advocacy groups, in this case ESMO for European medical oncology, the European Society for Surgical Oncology (ESSO) for European cancer surgery, and the European Society for Therapeutic Radiology and Oncology (ESTRO) for European radiation oncology. The political relationships within and between these organisations ebb and flow over time and are highly sensitive to leadership culture. The political domination of organisations engaged with the biopharmaceutical industries owes much of its political power to the extensive funding these organisations receive, in comparison, say, to surgical oncology. This ‘hierarchy of powers’ creates powerful sociopolitical global forces that influence everything from patient advocacy groups and professional behaviours and cultures through to the nature of how regulatory systems operate, including health technology assessment programmes, and narrowing down the priorities of cancer research. Overall, this political imbalance creates a pharmo‐technocentric environment that dominates contemporary cancer systems.

Key Issues in the Politics of Cancer Care

Cancer remains politically marginalised in many countries and to a greater degree at a supra‐national level. Reimagining the Future of Global Health Initiatives (2023