In 2017, the World Health Organization urged member states to develop and implement national cancer control plans (NCCPs) and to anticipate and promote cancer survivor follow-up care, which is a critical yet often overlooked component of NCCPs. This study aims to examine the inclusion of cancer survivorship-related strategies and objectives in NCCPs of African countries.
Independent reviewers extracted strategies, objectives, and associated indicators related to survivorship care from 21 current or recently expired NCCPs in African countries. Building on a similar analysis of the US state cancer control plans, reviewers categorized these strategies according to an adapted version of the ten recommendations for comprehensive survivorship care detailed in the 2006 National Academy of Medicine report.
A total of 202 survivorship-related strategies were identified, with all NCCPs including between 1 and 23 references to survivorship. Eighty-three (41%) strategies were linked to measurable indicators, and 128 (63%) of the survivorship-related strategies were explicitly focused on palliative care. The most frequent domains referenced were models of coordinated care (65 strategies), healthcare professional capacity (45), and developing and utilizing evidence-based guidelines (23). The least-referenced domains were survivorship care plans (4) and adequate and affordable health insurance (0).
The results of this study indicate that survivorship objectives and strategies should extend beyond palliative care to encompass all aspects of survivorship and should include indicators to measure progress.
Implications for cancer survivors
Stakeholders can use this baseline analysis to identify and address gaps in survivorship care at the national policy level.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
The data that supported the findings of this study are available in the ICCP Portal at https://www.iccp-portal.org/map. Analyzed data are available on request from the corresponding author.
Africa Palliative Care Association
Extension for community healthcare outcomes
Essential medicine list
International Cancer Control Partnership
Low- and middle-income country
Multinational Association of Supportive Care in Cancer
National Academy of Medicine
National cancer control plan
US National Coalition for Cancer Survivorship
Non-communicable disease plan
US National Cancer Institute
World Health Organization
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 2021;71(3):209–49.
Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet (London, England). 2018;391(10125):1023–75.
Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prevention : Pub Am Assoc Cancer Res, Cosponsored Am Soc Preventive Oncol. 2011;20(10):1996–2005.
The Global Cancer Observatory. Africa fact sheet. International Agency for Research on Cancer; 2020 March 2021.
Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, et al. Cancer in sub-Saharan Africa: a <em>Lancet Oncology</em> Commission. Lancet Oncol. 2022;23(6):e251–312.
National Comprehensive Cancer Network (NCCN). NCCN harmonized guidelines (Sub-Saharan Africa) - guidelines for supportive care: survivorship 2020 [Available from: https://www.nccn.org/global/what-we-do/harmonized-guidelines.
National Coalition for Cancer Survivorship (NCCS). Defining cancer survivorship 2022 [Available from: https://canceradvocacy.org/defining-cancer-survivorship/.
Medicine Io, Council NR. From cancer patient to cancer survivor: lost in transition. Hewitt M, Greenfield S, Stovall E, editors. Washington, DC: The National Academies Press; 2006. 534
World Health Organization (WHO), editor Cancer prevention and control in the context of an integrated approach. Seventieth World Health Assembly; 2017; Geneva: World Health Organizaiton (WHO).
Jacobsen PB, Mollica MA. Understanding and addressing global inequities in cancer survivorship care. 2019;1(1):e5.
Romero Y, Trapani D, Johnson S, Tittenbrun Z, Given L, Hohman K, et al. National cancer control plans: a global analysis. Lancet Oncol. 2018;19(10):e546–55.
Mollica MA, Falisi AL, Geiger AM, Jacobsen PB, Lunsford NB, Pratt-Chapman ML, et al. Survivorship objectives in comprehensive cancer control plans: a systematic review. J Cancer Survivorship : Res Practice. 2020;14(2):235–43.
Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Adler NE, Page AEK, editors. Washington, DC: The National Academies Press; 2008. 454
Hidde MC, Lyden K, Henry K, Leach HJ. Reallocating time to physical activity and sleep: associations with quality of life in cancer survivors. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2022:1–8.
Amo-Antwi K, Agambire R, Konney TO, Nguah SB, Dassah ET, Nartey Y, et al. Health-related quality of life among cervical cancer survivors at a tertiary hospital in Ghana. PLoS ONE. 2022;17(6):e0268831.
International Cancer Control Partnership. National Plans 2022 [Available from: https://www.iccp-portal.org/map.
Duncan K, Cira MK, Barango P, Trimble EL. Challenges and opportunities in the creation and implementation of cancer-control plans in Africa. Ecancermedicalscience. 2019;13:938.
Dy SM, Isenberg SR, Al Hamayel NA. Palliative care for cancer survivors. Med Clin North Am. 2017;101(6):1181–96.
Iwase S, Mori C. Palliative Care. In: Gellman MD, Turner JR, editors. Encyclopedia of behavioral medicine. Springer, New York: New York, NY; 2013. p. 1432–3.
WHO Expert Committee on Cancer Pain Relief and Active Supportive Care & World Health Organization. Cancer pain relief and palliative care report of a WHO expert committee. Geneva; 1990 3 to 10 July 1989.
Berman R, Davies A, Cooksley T, Gralla R, Carter L, Darlington E, et al. 2020 Supportive care an indispensable component of modern oncology. Clinical oncology (Royal College of Radiologists (Great Britain)) 32(11):781–8.
Ministry of Health and Population GotRoM. National Cancer Control Strategic Plan. 2019.
National Cancer Institute. NCI Dictionaries "survivorship" 2022 [Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivorship?redirect=true.
Survivorship NCfC. Defining Cancer Survivorship 2022 [Available from: https://canceradvocacy.org/defining-cancer-survivorship/.
Rubagumya F, Mitera G, Ka S, Manirakiza A, Decuir P, Msadabwe SC, et al. Choosing wisely Africa: ten low-value or harmful practices that should be avoided in cancer care. JCO global oncology. 2020;6:1192–9.
African Palliative Care Association. African Palliative Care Association 2022 [Available from: https://www.africanpalliativecare.org/.
Oar A, Moraes FY, Romero Y, Ilbawi A, Yap ML. Core elements of national cancer control plans: a tool to support plan development and review. Lancet Oncol. 2019;20(11):e645–52.
WHO Regional Office for Africa. The state of the health workforce in the WHO African Region, 2021. Brazzacille, Congo: World Health Organization (WHO); 2021.
Vanderpuye V, Hammad N, Martei Y, Hopman WM, Fundytus A, Sullivan R, et al. Cancer care workforce in Africa: perspectives from a global survey. Infectious Agents and Cancer. 2019;14(1):11.
Yabroff KR, Han X, Song W, Zhao J, Nogueira L, Pollack CE, et al. Association of medical financial hardship and mortality among cancer survivors in the United States. J Natl Cancer Inst. 2022;114(6):863–70.
Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. JNCI: Journal of the National Cancer Institute. 2016;109(2).
Donkor A, Atuwo-Ampoh VD, Yakanu F, Torgbenu E, Ameyaw EK, Kitson-Mills D, et al. Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2022.
Private Cancer Physicians of Australia and Rare Cancers Australia. Cancer Care, no gaps: protectins Australian cacner patients, and their families, from financial toxicity. 2022.
Martha Stutsky CH. Assessing the impact of patient assistance programs on financial toxicity in oral oncology. Pharmacy Times. 2022 June 2022.
Razis E, Kassapian M, Andriakopoulou C, Martei YM, Zurn SJ, Hammad N, et al. Essential medicines list in national cancer control plans: a secondary analysis from a global study. Lancet Oncol. 2022;23(3):e144–54.
Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet (London, England). 2018;391(10128):1391–454.
Duangchan C, Steffen A, Matthews AK. Perspectives and practices regarding colorectal cancer survivorship care: online survey results from oncology nurses in Thailand. Eur J Oncol Nursing : official J European Oncol Nursing Soc. 2021;55:102048.
Chidebe RCW, Pratt-Chapman ML. Oncology patient navigation training: results of a pilot study in Nigeria. Journal of cancer education : the official journal of the American Association for Cancer Education. 2021:1–7.
Lasebikan N, Nakaganda A, Fadelu T, Ibeka P, Haskins L, Cira M. Demonstration of impact through the evaluation of the 2020–2021 Africa cancer research and control ECHO. 2022;8(Supplement_1):37-.
Harvey A, Zhang Y, Phillips S, Suarez R, Dekle L, Villalobos A, et al. Initial outcomes of an online continuing education series focused on post-treatment cancer survivorship care. J Cancer Educ : Official J Am Assoc Cancer Educ. 2020;35(1):144–50.
Nolan TS, Hatfield R, Browning KK, Kue J, Klemanski DL. Survivorship fellowship: evaluation and evolution of a program for advanced practice providers. Clin J Oncol Nurs. 2019;23(6):575–8.
We thank the experts who reviewed this manuscript: Kalina Duncan (Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA, Mandi L. Pratt-Chapman (George Washington University, Washington D.C., USA), and Timiya S. Nolan (The Ohio State University, Columbus, OH, USA. Thank you to Alicia A. Livinski (NIH Library, NIH, Bethesda, MD, USA) for the manuscript review, editing, and formatting.
The authors declare no competing interests.
Ethical approval was not required for this study.
Conflict of interest
The authors declare no competing interests.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, National Institutes of Health or US government or any of the authors’ organization.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Garton, E.M., Ali, Z., Cira, M.K. et al. An analysis of survivorship care strategies in national cancer control plans in Africa. J Cancer Surviv 17, 634–645 (2023). https://doi.org/10.1007/s11764-022-01320-x