Comprehensive cancer control planning in the Pacific: the Cancer Council of the Pacific Islands a multi-national regional coalition.

INTRODUCTION: In the early 1990s, a comprehensive cancer control (CCC) approach was developed in the United States (US). In 2003, the US-Affiliated Pacific Islands (USAPI) adopted the CCC approach through a regional coalition, the Cancer Council of the Pacific Islands (CCPI). Using the CCC approach, the CCPI developed jurisdiction-specific cancer coalitions and initiated their respective cancer plans. METHODS: The evolution of the CCC approach and the history of the CCPI regional coalition are reviewed. The outcomes of the regional approach for cancer control in the USAPI are described to illustrate the possibilities, value-added and innovation of using a CCC strategy in a multi-national coalition based in a resource-limited environment. RESULTS: The CCC approach enabled the CCPI to (1) harmonize cancer control efforts between the six USAPI jurisdictions, (2) represent the USAPI cancer needs as a single voice, and (3) develop a regional cancer control strategy. Outcomes include (1) a regional cancer registry, (2) three sequential regional CCC plans, (3) leveraged resources for the USAPI, (4) enhanced on-site technical assistance and training, (5) improved standards for cancer screening, (6) evidence-based cancer control interventions adapted for the USAPI. CONCLUSION: The regional CCPI coupled with the CCC approach is an effective engine of change. The CCC strategies enabled navigation of the political, geographic, cultural, and epidemiologic Pacific environment. The regional partners have been able to harmonize cancer control efforts in resource-limited settings. Regional cancer coalitions may be effective in the global arena for cancer control between communities, states, or countries.

Research and comprehensive cancer control coalitions.

The goal of cancer control research is "to generate basic knowledge about how to monitor and change individual and collective behavior and to ensure that knowledge is translated into practice and policy rapidly, effectively, and efficiently" (Division of Cancer Control and Population Sciences in Cancer control framework and synthese rationale, 2010). Research activities span the cancer control continuum from prevention to early detection and diagnosis through treatment and survivorship (Division of Cancer Control and Population Sciences in Cancer control framework and synthese rationale, 2010). While significant advancements have been made in understanding, preventing and treating cancer in the past few decades, these benefits have yielded disproportionate results in cancer morbidity and mortality across various socioeconomic and racial/ethnic subgroups (Ozols et al in J Clin Oncol, 25(1):146-1622, 2007). It has been a high priority since the beginning of the Comprehensive Cancer Control (CCC) movement to utilize research in the development and implementation of cancer plans in the states, tribes and tribal organizations, territories and US Pacific Island Jurisdictions. Nevertheless, dissemination and implementation of research in coalition activities has been challenging for many programs. Lessons learned from programs and coalitions in the implementation and evaluation of CCC activities, as well as resources provided by national partners, can assist coalitions with the translation of research into practice.

Cancer in the US Associated Pacific Islands (UASPI): history and participatory development.

The US-associated Pacific Island jurisdictions (USAPI) have great disparities in health care and comprehensive cancer care compared to the United States. Cancer mortality ranks first or second among the leading causes of death in most of these island nations. The USAPI has formed the Cancer Council of the Pacific Islands (CCPI), an indigenous council to identify and address the cancer health disparities of the region. The CCPI efforts were formally launched in 2002 with the support of the Center to Reduce Cancer Health Disparities, a Center of the National Cancer Institute (CRCHD-NCI) and the National Center for Minority Health Disparities, a Center of the National Institutes of Health (NCMHD-NIH). Facilitating partners are the Department of Family Medicine and Community Health, University of Hawai'i and 'Imi Hale - Native Hawaiian Cancer Network, a program of Papa Ola Lokahi. The objectives of this initiative are to describe and address the cancer health disparities in the USAPI. Over the past 2 years there has been considerable progress in identifying and prioritizing cancer prevention and control needs; launching cancer prevention and control efforts in each of the jurisdictions; and leveraging additional funding to support ongoing activities. The support from the Center to Reduce Cancer Health Disparities in fostering a participatory model of development has been landmark in the establishment and implementation of this initiative. This manuscript provides a historical background on cancer in the USAPI and prefaces 9 cancer assessments in this journal from the Commonwealth of the Northern Mariana Islands, Guam, American Samoa, Republic of the Marshall Islands, Republic of Belau, and the four states (Yap, Pohnpei, Kosrae and Chuuk) of the Federated States of Micronesia.

Epidemiology of cancer in the Republic of Kiribati.

Little is known about cancer epidemiology in Kiribati. Between November 1998 and December 1999, trained medical record abstractors visited 8 Micronesian jurisdictions including the Republic of Kiribati to review all available medical records in order to describe the epidemiology of cancer in Micronesia and to better understand the cancer data and control systems in each entity. The Republic of Kiribati has identified many prevalent preventable cancers. The lack of a robust cancer data tracking and surveillance system, as well as the lack of resources to institute a technologically and medically sustainable cancer control system was apparent. The implementation or existence of a national comprehensive cancer control strategic plan would facilitate greater identification, prevention, and treatment of cancer patients. The health sector and Government of Kiribati are working towards this end.

Epidemiology of cancer in the Republic of Nauru.

Between November 1998 and December 1999, the Republic of Nauru was one of 8 Micronesian jurisdictions visited by trained medical record abstractors to review all available medical records in order to describe the epidemiology of cancer in Micronesia and to better understand the cancer data and control systems in each entity. There is likely incomplete ascertainment of cancer cases in the Republic of Nauru because of historical events, and the lack of a robust cancer registry and a systematic cancer surveillance system. A national comprehensive cancer control strategic plan and the implementation of that plan would facilitate greater prevention, treatment and control of cancer. The government of Nauru is working towards this end.