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Cancer database for the Western Pacific Region : essential features and data analysis

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Cancer Database for the Western Pacific Region

Essential features and data analysis

World Health Organization Regional Office for the Western Pacific Manila, Philippines 1999

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Cancer Database for the Western Pacific Region: Essential features and data analysis

This document is not a formal publication of the World Health Organization (WHO) and all rights are reserved by the organization. The document may, however, be freely reviewed, reproduced or translated in part, but not for sale or for use in conjunction with commercial purposes.

For authorization to reproduce or translate the work in full, and for any use by commercial entities, applications and inquiries should be addressed to the Publications Unit, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND OATAANAl.VSIS

Table of contents

Foreword Acknowledgments Purpose of the Cancer Database Presentation of the WPRO Cancer Database Contents Limitations Development of the Cancer Database Development of the questionnaire Data collection by means of the questionnaire Data extraction from the CHIP Cancer incidence rates Other sources of information Essential results Bases for analysis Cancer burden Causes of death Cancer incidences Cancer control policies Major axes of cancer control A cancer control policy/activity score Components of policy/activity score by country Determinants of cancer control policy/activity Population structure Neoplasms as leading cause of death Barriers to the establishment of cancer control activities Specific activities Primary prevention Early detection Treatment Palliative care Comment Appendix 1 - The Questionnaire Appendix 2 - Individual country profiles

1 2 2

3 4 4 5 5

5 6 7 7 9 9 10 12 12 13 13 17 17 17

18 18 19 19

20 21

22 25 30

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL VSIS

Foreword

I am delighted that the Cancer Database for the Western Pacific - Essential Features and Data Analysis developed by the Western Pacific Regional Office of the World Health Organization is now being published. The Database provides not only epidemiological data such as cancer incidence, but also information on cancer control activities at the country level. It may be used to describe the general cancer burden, to help in planning interventions, to monitor the development of cancer control programmes over time and to evaluate what has been done in cancer control at country and regional levels. It also provides easy access to information from various sources on each country of the WHO Western Pacific Region. Several published sources of information have been used to compile this material, as well as detailed questionnaires filled out in each country by the local responsible authority for cancer control. Publication of the Cancer Database for the Western Pacific Region will provide a scientific basis for development, implementation and evaluation of national cancer policies and programmes. I hope that in future more frequent and improved research and analysis on cancer control will strengthen evidence-based practice in cancer control in the Region.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES ANO DATA ANALYSIS

Acknowledgments

We would like to thank Dr Sandro Pampallona, forMed, 1983 Evoleme, Switzerland and Dr Han Tieru, Regional Adviser for Noncommunicable Diseases, WHO Regional Office for the Western Pacific, Manila, Philippines for their extensive contributions to this document.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Purpose of the Cancer Database

Availability of baseline data on cancer, including cancer incidence and mortality, has generally improved at country and regional level due to strengthening of epidemiological expertise and development of cancer registries. There is no doubt that these data form a significant basis for development of national cancer control policies and programmes. However, lack of data on cancer control activities at country level has become an obstacle for assessment of efficiency and effectiveness of these policies and programmes. It is intended that the Cancer Database will provide a reference to structured information not only on cancer incidence but also on cancer control at country level, and that this information will be used to help in planning interventions, monitoring the development of cancer control activities and conducting general evaluations of cancer control activities in countries and the Region as a whole. At the same time, the Database provides a tool for easy organization of reference materials in the form of an indexed bibliography of material relevant to cancer control activities, whether or not linked to speCific countries of the Region.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Presentation of the WPRO Cancer Database

Contents Five types of information are contained in the database for each country of the Western Pacific Region:

(1) essential demographic and health indicators (from the most recent edition of the Country Health Information Profile' [CHIP]); (2) leading causes of death (from the most recent edition of the CHIP); (3) ranking of the five most frequent cancer sites (from the most recent edition of Globocan 12 [GLOBOCAN]); (4) answers to the specially designed questionnaire on cancer control policies and activities at country level, filled out in each country by the local responsible authority for cancer control; and (5) other published material (ministry of health reports, scientific papers, vital statistics, etc) related to aspect of cancer control of relevance to WPRO and indexed in the Database by means of over 20 key words.

, Country Health Information Profile, 1997 ReviSion, WHO, Regional Office for the Western Pacific, Manila, Philippines, 1997. 2

Globocan 1, Cancer Incidence and Mortality Worldwide, J Ferlay, DM Parkin, P Pisani, IARC Press, WHO International Agency for Research on Cancer, Lyon 1998.

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CANCER DATABASE FOR THE INESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Limitations It should be pointed out that data from the CHIP come from countries with health information systems of varying quality and may often be incomplete or not up to date. Similarly, only a small number of countries and areas of the Western Pacific Region have comprehensive and reliable systems of registration for cancer incidence. Therefore, the synthesis provided in GLOBOCAN is also to be considered with caution, especially for the smallest countries. Please refer to both publications for more details about methods and limitations of either source. As regards the questionnaires, though all efforts have been made by the WHO Regional Office for the Western Pacific and Country representatives to forward these to the national cancer control authorities, they do not represent an in-depth study of cancer policies. Accordingly, in some cases they may reflect the subjective impression of the officials who have filled them in. However, although the material it contains is relatively soft in nature and of varying quality, the Cancer Database nonetheless represents an effort to synthesize the cancer burden and cancer control policies and activities in the Region.

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CANCER DATABASE FOR THE 'MOSTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Development of the Cancer Database

Development of the questionnaire To describe the current situation as regards ongoing cancer control activities in each country and area of Western Pacific Region, a three-page questionnaire has been developed containing the following six sections: A. Cancer burden; B. Aspects of policy of cancer control; C. Primary prevention; D. Early detection; E. Treatment; and .F. Palliative care. A copy of the questionnaire is attached as Appendix 1. The questions attempt to translate into indicators the axes of evaluation of progress and outcome suggested in the WHO publication 3 on policies and managerial guidelines for national cancer control programmes (NCCPs). The questionnaire is certainly not meant to replace an in-depth analysis of cancer control policies, but, nonetheless, it attempts to provide an accurate rendition of the local situation based on simple descriptors. In several instances, however, a compromise has had to be found between the precision of both the question asked and the expected answers on one hand and practicality on the other.

National Cancer Control Programmes: Policies and Managerial Guidelines. Geneva, World Health Organization, 1993.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Data collection by means of the questionnaire The questionnaires were sent to governments of all countries and areas of the Region in late Spring 1997 . The questionnaires have invariably been completed by an official of a governmental institution, in the vast majority of cases the Department of Health Services (or similar) of the Ministry of Health. The questionnaires were returned by 29 out of the 37 countries and areas of the Western Pacific Region. No attempt has been made to correct the received material on the basis of other sources of information, though a check for internal consistency has been applied. It has never been necessary to obtain additional information from the original source, although several reminders had to be issued. The last questionnaire considered in the current report was received on 30 September 1998, when the data collection effort has been considered closed. In some instances, countries provided data on cancer incidence and mortality which have been indexed in the database and are available at the Non-Communicable Diseases Unit, World Health Organization, Regional Office for the Western Pacific.

Data extraction from the CHIP The 1997 edition of the CHIP has been used to extract essential health indicators to complete the profile of each country and area. For the Pitcairn Island, data was not available in the CHIP. Since the CHIP contains official data supplied by the countries and areas of the Region, no attempt has been made to recover the missing data for Pitcairn Island from other sources.

Cancer incidence rates The ranking of the five most frequent cancer sites, in women and men separately, has been extracted for the 20 countries considered in GLOBOCAN. The choice to report the ranking rather than the actual figures themselves was made in order to reduce the chances of over-interpretation of these data. As explained in GLOBOCAN, the sources of cancer incidence are of very different quality and coverage and relate to different time periods. Within the Data-Base it was required to only give a qualitative indication of the cancer burden.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALVSIS

Other sources of information The Cancer database contains numerous citations, linked to specific countries or of more general interest, but always related to various aspects of the cancer burden, control policies or activities of relevance to the Western Pacific Region. This material has been identified from various sources, but primarily through bibliographic searches (for published articles) and review of the material available at the WHO Regional Office for the Western Pacific library and at the library of WHO Headquarters. This material is indexed by means of over 20 key words, allowing easy cataloguing and retrieval. A complete or partial copy of each of the documents cited is available at the Noncommunicable Diseases Unit, WHOWPRO and can be identified by means of a unique number indexing the citations. Additions to the list of information sources currently in t::'e database c;m be made at any time.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Essential results

Bases for analysis Of the countries of the Westem Pacific Region, data is available from the CH IP report (1997 Revision) for all except Pitcaim Island, thus for a total of 36 countries and areas. Cancer incidence data is available from GLOBOCAN for 20, while 29 have retumed the questionnaire. Table 1 summarizes data availability by country.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

Table 1. Data availability from the 37 countries and areas of the Region.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl. FEATURES AND DATA ANALYSIS

Cancer burden Causes of death Causes of death were not available in the CHIP for Wallis and Futuna. The causes of death, which ranked first and second in the Region, are shown in Tables 2 and 3. Noncommunicable diseases are the first cause of death in 26 countries and areas, and among these neoplasm ranks first in 8. Table 2. Causes of death ranked first Cause of death Diseases of the circulatory system Neoplasms Pneumonia Injuries and/or accidents Diarrhoea Malaria Neonatal Respiratory system Senility N. of countries

18 8

2 2 1 1

1 1

Table 3. Causes of death ranked second

Cause of death Diseases of the circulatory system Neoplasms Respiratory system Pneumonia Injuries and/or accidents Chemical toxicosis Diabetes Diarrhoea Infectious and parasitic Perinatal Senility Septicemia

N. of countries

11 6

5 4

2 1 1 1 1 1 1 1

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Table 4 lists the countries or areas where neoplasm ranked first, second or third cause of death. Table 4. Ranking of neoplasm as cause of death

Cancer incidences I n men, cancers of the lung/bronchus/trachea ranked first in 7 of the 20 countries and areas analysed, second in 5 countries and third in 3 countries. Liver, colon/rectum, stomach and oral cancers were generally among the most frequent cancers in several countries or areas. In women, breast cancer ranked first in 10 countries or areas, second in 7 countries and third in 3 countries, closely followed by cervical cancer. Lung/bronchus/trachea, colonl rectum and stomach were among the sites most frequently reported. Additional details are given in Tables 5 and 6.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Table 5. Ranking and corresponding frequency of cancer incidence in men by site in 20 countries and areas of the Region.

Ranking Site (N. of countries or areas)

1st 2nd 3"' Lung/BronchusfTrachea Liver Colon/Rectum Stomach Oral cavity/Nasopharinx Lymphatic/Hematopoietic Prostate Skin/Melanoma Oesophagus Bladder Pancreas Thyroid

4th 5th 1 4

4 1

8 5

1 6

2 1

3 7

2 3

2 1

2 2 2

1 1

Table 6. Ranking and corresponding frequency of cancer incidence in women by site in 20 countries and areas of the Region. Ranking Site (N. of countries or areas)

1" 2nd 3"' 4th 5th Breast Cervix Lung/BronchusiTrachea Colon/Rectum Stomach Liver Ovary Uterus Oral cavijy/Nasopharynx SkinlMelanoma Lymphatic/Hematopoietic Thyroid Oesophagus

10 7

2 3 4

2 6 3

3 3 4

3 4

1 2 4

2 1 4

2 2 1 2 2

2 1

-- 11 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Cancer control policies Major axes of cancer control To describe the main aspects of national cancer control policies and activities as concerns overall coordination, prevention, early detection, treatment and palliative care, 14 items from the questionnaire were selected. Table 7 gives the observed frequency in the 29 countries and areas having returned the questionnaire. This selection attempts to cover the main axes of policy and implementation of cancer control programmes as proposed by WH04.

Table 7. Adopted policies and implemented activities.

Policy - Activity

Number of countries or areas

Overall coordination Focal point for coordination of cancer control activities Policies for muttisectoral effort to manage activities in cancer control Existence of a national cancer society Presence of a systematic evaluation of the progress made in cancer control

12 14 16 4 17

Prlmary prevention Presence of a national strategic programme for tobacco control Legislation passed regulating tobacco sales/advertisement/smoking Routine infant vaccination against hepatitis-B

15 25 15 22 8

Early detection Screening for breast cancer routinely offered to women Screening for cervical cancer routinely offered to women

Treatment WHO list of cancer chemotherapy essential drugs formally adopted Presence of well-established cancer treatment guidelines Presence of well-established guidelines for referral/follow-up of cancer patients

14 17 7

Palliative care Curriculum developed for training in palliative care Legislation passed to make morphine available for the treatment of cancer pain

Ibid: 4.

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CANCER DATABASE FOR lliE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

A cancer control policy/activity score The primary aim of the Cancer database is to document cancer control activities in the Region. It is therefore appropriate to attempt to quantify the level of attention to the problem shown by each country, in terms of a composite score. For the purpose of this analysis, all the 14 items concerning policies and activities listed in Table 7 have been considered. The total number of adopted policies and implemented activities (answer ·Yes" to the corresponding item) has been counted. The score values can therefore go from 0 (interpreted in this report as no attention to cancer control) to 14 (interpreted in this report as maximum attention). This index is clearly not intended to capture the level of efficacy of the steps taken to reduceg the cancer burden within the Region but only to quantify the level of activity. For the 29 countries and areas with data from the Questionnaire, this score has a median of 6 and a range of 1 to 13 (no country had implemented all 14 policies and activities contributing to the score).

Components ojpolicy/activity score by country Table 8 details the items contributing to the policy/activity score for each country and area of the Region, ordered by increasing value of the score. Policies and activities are ordered by frequency of occurrence. Among the countries and areas with a score of 7 or less, hepatitis B vaccination and cervical cancer screening were the activities/policies more frequently implemented. Presence of a national tobacco control programme and established referral and treatment guidelines for cancer patients were the next most frequent items contributing to the score. Among the countries and areas with a policy score of 8 or more, adoption of the WHO list of cancer chemotherapy essential drugs, development of a curriculum for palliative care and systematic evaluation of the progress made in cancer control were the items less frequently implemented.

-- 13 --

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND OATAANALVSIS

Determinants of cancer control policy/activity It is possible to investigate which factors affect the policy/activity score, in order to establish whether the Region as a whole responds to cancer proportionally to its importance. Among these, population age structure, ranking of neoplasm as cause of death, and barriers acting on implementation of cancer control activities are considered in this report.

Population structure Increasing incidences of cancer are generally associated with the ageing of a population. Figure 1 displays the association between the policy/activity score and the percentage of individuals of age 65 or older. As one would expect, the graph suggests a positive association: countries with higher proportions of older people have taken more steps in cancer control activities.

Figure 1. Policy/Activity score in relation to population structure. 14 12 III U III

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Neoplasms as leading cause of death If one considers the leading causes of death, neoplasm appears as the first cause in 8 countries and in 6 countries as the second cause. The median policy/activity score according to the ranking of neoplasm as cause of death suggests a trend in the expected direction: in the countries where neoplasm ranks first the median score is 9.5, where it is second it is 8 and in all other countries it is 6.

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CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Barriers to the establishment of cancer control activities The questionnaire asked about barriers affecting the realization of cancer control activities. In Table 8 they are considered in relation to the policy/activity score to see which ones negatively affects the level of attention given to the cancer problem. Consistently with the previous findings, where cancer is not a major problem, the policy/activity score is lower. This is also the case where there is a shortage of qualified personnel or a shortage of funds. Interestingly enough, whether the Ministry of Health gives low or high priority to cancer does not affect the policy/activity score. Similarly, in a Region where there are rather small countries and areas isolated in the Pacific Ocean, often made up of numerous islands, as well as rather large countries with low population density, the geographical configuration does not playa major role.

Table 9. Barriers in relation to policy/activity score.

Barrier

Countries and areas where barrier is present

Countries and areas where barrier is not present

N. Low priority given to cancer by Ministry of Health Cancer not a major health problem Shortage of qualified personnel in oncological disciplines Cultural. societal, religious factors Shortage of funds Geographical configuration of country

Median policyl activity score 6.0 3.5 6.0 5.0 6.0 5.0

N. Median policyl activity score 20 25 9

9 4

6.5 7.0 10.0 6.5 9.5 6.5

20 9

21 9

8 20

Specific activities The activity level in the areas of primary prevention and palliative care deserve special attention since they represent core activities in cancer control that s~ould be .. established everywhere and require modest resources for their implementation. Additionally, in contrast with early detection and treatment, they are less sensitive to t~e availabilit.y ~f medical technology, skilled personnel and funding. Basic data on prevention and palliative care activities as collected through the questionnaire can therefore be presented independentl~ from an assessment of the health care policy at country level. This is not the case for early detection and treatment and the data provided for these two areas has to be interpreted with caution.

-- 18 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Primary prevention Table 10 presents the percentage of countries with established regional or nationwide activities in the six areas of primary prevention covered by the questionnaire. Existence of any established programme addressed to either children. adolescents, general population or speCific target groups have been considered as an indication of activity in the corresponding area. Additionally, the existence of Hepatitis B vaccination programmes is also considered. Table 10. Primary prevention activities.

Area of activity Diet and exercise Smoking and/or tobacco chewing Alcohol and/or drug abuse Sexual education Sunlight exposure Occupational hazards Hepatitis B vaccination

Percentage of countries and areas (n=29) with established regional or nation-wide activity

41 48 48 59

17 14 86

Early detection The questionnaire. beside the items reported in Table 11, also asked questions on the percentage of coverage for screening activities, the percentage of cancers detected through screening and the percentage of cancers detected at advanced stages. Almost invariably. data was not provided to these more quantitative questions. Additionally, the possibility cannot be excluded that, when asked about "offering routine screening" for breast and cervical cancer, responders answered "Yes" even in the absence of a structured countrywide programme simply if general practitioners usually advise women to undergo screening tests.

-- 19 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Table 11. Early detection activities.

Area of activity Breast cancer screening routinely offered to women Cervical cancer screening routinely offered to women Early detection programme for oral cancer Early detection programme for skin cancer Primary health care workers trained in value of early detection capable of referring patients for diagnosis

Percentage of countries and areas (n=29) with established regional or nation-wide activity

52 75 3 6

Treatment Treatment of cancer requires financial and technical resources which are not present in many of the countries or areas of the Region. In addition, the picture drawn by Table 12, although acceptable for purely descriptive purposes, does not provide insight on the coverage and quality of treatment delivered. Table 12. Treatment activities.

Area of activity Existence of comprehensive specialized cancer treatment centers WHO list of cancer chemotherapy essential drug adopted Treatment guidelines established Availability of external radiotherapy equipment Availability of internal radiotherapy equipment Follow-up guidelines established

Percentage of countries and areas (n=29) with established regional or nationwide activity

27 48 41 41

-- 20 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

Palliative care The questionnaire included items on essential indicators of implementation of palliative care activities. Table 13 summarizes a selection of these. . Table 13. Palliative care activities.

Area of activity Patients and family are informed of possibility to alleviate cancer symptoms Families are instructed on simple methods of home care A curriculum for palliative care has been developed Primary health care workers receive training in palliative care Hospitals have generally adopted WHO guidelines for palliative care Legislation has been passed to make morphine available for cancer pain relief Morphine is available at primary health care level There is a national SOCiety for palliative care

Percentage of countries and areas (n=29) with activity implemented

48 62 24 21 21 48 41 28

-- 21 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

Comment

A comprehensive and coherent assessment of health indicators represents a complex challenge. This is especially true in an area of the world where countries and areas are very different in so many relevant respects. Additionally, the quality of the data collected is affected by varying standards of health information available. Also, the possibility cannot be excluded that questions have been misinterpreted or that the officials filling in the questionnaire could not be relied upon for a valid and comprehensive assessment of the local situation. Nonetheless, this effort has provided some informative insights on the cancer control policies in the Western Pacific Region, which represent a useful reference for future monitoring and follow-up. In particular, the following aspects emerge:

Cancer certainly represents a sizeable health problem in the majority of countries and areas of the Region. Lung, liver and stomach cancer and breast, cervical and lung cancer are the most frequent cancer sites reported in men and women, respectively. Countries and areas seem to have adopted pOlicies and activities in response to the relative distribution of causes of death and population structure. • Shortages of qualified personnel and of funding are perceived as the main barriers to the implementation of cancer control policies. Routine hepatitis B vaccination, cervical cancer screening, a national tobacco control programme and referral and follow-up of cancer patients are among the activities implemented in most countries and areas. Primary prevention activities, with the exception of hepatitis B vaccination and sexual education, are implemented in less than half of the countries and areas of the Region. Training in palliative care is implemented in one country out of five and morphine legislation has been passes in fewer than half of the countries and areas of the Region. Monitoring of progress in cancer control is routinely done in only four countries.

•

-- 22 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANIAL YSIS

The collected data provides a moderately encouraging picture of the current cancer control efforts in the Western Pacific Region. A more intensive effort in primary prevention and palliative care is certainly needed as well as the establishment of monitoring and evaluation strategies. The population of the Region totals over 1.6 billion individuals living in countries with varying degree of resources and development. The continuing support of WHO is essential to consistently guide the establishment of comprehensive cancer control programmes in the Western Pacific countries and areas. Repeated use of the questionnaire will allow monitoring of progress of such activities, for which the material provided in this report represents a suitable baseline.

-- 23 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAl YSIS

Appendix 1 - The Questionnaire

-- 25 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

World Health Organisation - WPRO Manila, Philippines Questionnaire on the cancer situation in the Western PaCific Region Please answer as many questions as possible. If the information requested is not available or is not known by you please indicate so with a question mark. COUNTRY ................................................................................ A. Cancer burden What is the source of cancer incidence and mortality data? No 0 Nation-wide registration of all incident cases Yes 0 No 0 Cancer registry in one or more areas, if Yes % of national population covered .. ......... % Yes 0 No 0 Hospital-based information systems Yes 0 No 0 Ad-hoc sample sUlVeys Yes 0 No 0 OffiCial mortality statistics Yes 0 Yes 0 No 0 Other, specify Estimated national cancer incidence Please attach to this questionnaire tables reporting number of new cases per year and the corresponding crude rate per 100,000 population Of incidence is not available then provide mortality data in the same form) as well as the year the data refer to and the source (with full reference of published material if applicable): - overall cancer incidence - incidence of the ten most frequent cancers - incidence of lung cancer if not among ten leading sites. Note: if you only h.ave national or regional data available in other form than specified above please attach it anyway specifying the year of estimation and the source. Estimated national cancer incidence by gender and by age If available please attach to this questionnaire the same data specified in the previous question but split according to gender and according to age. If you have data by age for each gender please attach it as well. Has there been a significant increase or decrease in the incidence of cancer(s) over the past 10-20 years ? 0 No 0 increase if Yes specify site(s), rates and years of estimation .......... ...... .........•...•......•..•.•...................•...••.....•....•.•••...•..•••.•...••...•••.••..•.•.••.•...•• ............................................................................................................................ decrease Yes 0 No 0 if Yes specify site(s), rates and years of estimation ..•••....•...••...••...•••....•...................••.....•........•...•....••...•...•...••...•..••...•...••...•... .... .... ............................... ...... .....................................................................................

Yes

B. Aspects of policy of cancer control Yes Yes

0 0

No No

0 0

Does your country have a focal pOint for the co-ordination of cancer control activities? Has the country adopted policies for a multisectoral and multidisciplinary effort to manage activities in cancer control? Since what year ............ and do these policies reflect the WHO model of primary prevention, earty diagnosis, treatment and palliation (National Cancer Control Programme, Policies and Managerial Guidelines, WHO, 1995)?

If Yes to above Yes 0 No 0

Does any Yes 0 Yes 0 Yes 0 Yes 0 Yes 0 Yes 0 Yes 0

of the following represent a barrier to the establishment of cancer control activities? No 0 Low priority given to cancer by Ministry of Health No 0 Cancer is not a major heath problem No 0 Shortage of qualified personnel in oncological disciplines No 0 Cultural, societal or religious factors No 0 Shortage of funds No 0 Geographical configuration of the country No 0 Other, if Yes specify ..... , ................................... , '" ................... " .............

-- 27 --

CANCER DATABASE FOR THE \/\/ESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

Have national or regional sample surveys been conducted or are being conducted? No 0 On exposure to known risk factors for the development of cancer Yes 0 Yes 0 No 0 On knowledge, attitudes and practices (KAP) about various life-styles Yes Yes

0 0

No No

0 0

Does a national Cancer Society or other similar agency exist? Is there a systematic evaluation of the progress made in cancer control? if Yes, please attach to this guestionnaire a copy ofthe most recent report if available

C, Primary prevention Conceming efforts in Health Education and Health Promotion please indicate which of A, B or C best describes the current level of activity in the 6 areas listed below (consider any combination of advertising on press, radio or TV, school curricula, distribution of material, organisation of special events or any other intervention): A = currently no activity B = limited interventions (even if currently under development or if experimental) C established regional or nation-wide programmes

Diet and exercise

Smoking and/or tobacco chewing

Alcohol andlor drug abuse

Sexual education

Sunlight exposure

Occupational hazards

For children and adolescents For general population For specific target groups Yes 0 No 0 If Yes to above No 0 Yes 0 Yes 0 No 0 If Yes to above Is there a national strategic programme for tobacco control? Since what year ............ and has legislation regulating tobacco sales/advertisement/smoking been passed? Is there a routine vaccination of infants against Hepatitis-B? Estimated coverage (as a percentage of all children under 1 year of age) ............ % and year of its estimation ............

D. Early detection Yes 0 No 0 If Yes to above Yes Yes Is screening for breast cancer routinely Offered to women? Since what year .... , ........ and estimated coverage of intended target population ............ % and is mammography part of the screening procedures? Is cervical cancer screening routinely offered to women? Since what year .............. and estimated coverage of intended target population ............ % and is cytology part of the screening procedures?

0 0 0

No No

0 0 0

If Yes to above Yes No

Are there early detection programmes for Yes 0 No 0 Oral cancer No 0 Skin cancer Yes 0 What is the percentage of all cancers diagnosed through screening or early detection programmes? ............ % What is the proportion of all cancer cases diagnosed at an advanced (generally not curable) stage? You may give data for specific sites and/or overall, depending on availability. All sites, diagnosed at advanced stage ............ % Site .................................... '" ......... diagnosed at advanced stage ................ % Site ............................................... , diagnosed at advanced stage ................ % Site ................................................ diagnosed at advanced stage ................ % Site ................................................ diagnosed at advanced stage ................ % Yes

Are Primary Health Workers routinely trained in the value of early detection for the potential cure of cancers and are they in a position to refer patients for diagnosis?

-- 28 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

E. Treatment Yes Yes Yes Yes Yes Yes Yes Yes

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

No No No No No No No No

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Are there comprehensive cancer centres specialised in the diagnosis and treatment of cancer? If Yes. number ............ Are chemotherapy drugs for cancer treatment generally available? Has the WHO list of essential drugs for cancer chemotherapy been fonmally adopted? Are there well established treatment guidelines? External radiation therapy equipment is available? if Yes number of machines ............ Intemal radiation therapy is available? Are there well established referral and follow-up guidelines? What percentage of patients diagnosed with a curable cancer receive treatment?

F. palliative care ..

Yes Yes Yes Yes Yes Yes

No No No No No No

Do patients and their families generally know that cancer symptoms can be alleviated? Are families told the simple methods of home care to alleviate symptoms of cancer patients? Terminal patients receive palliative care at home? If Yes, percentage ............ % Has a curriculum for training in palliative care been developed? Primary Health Workers receive training in palliative care? If Yes, percentage ............ % Hospitals have adopted the WHO guidelines for palliative care? If Yes, percentage ............ %

Yes If Yes to Yes 0 Yes 0 Yes 0 Yes 0 Yes 0 Yes

Has legislation been passed to make morphine available for the treatment of cancer pain? No above, does any of the following represent a barrier to its implementation? No 0 complex prescription procedures No 0 complex prescription reporting procedures to national narcotics board No 0 unavailability of drug No 0 misconceptions about its side effects (dependency) No 0 other, if Yes specify ... .....•••.....•••...•. , ............................. , ..............•....................... ,' No

Is morphine available at the Primary Health Care level? "

What percentage of terminal cancer patients receive morphine? ............ % What is the total per capita consumption of morphine? ................ specify units ................ Yes

Is there a national society for palliative care?

Please give the full name, position and professional address (capital letters) of yourself and of second resource person in your country whom we might also contact for information on cancer control activities. Your address The address of a second resource person

Please do not forget to include with this questionnaire: 1. cancer incidence and mortality material, as requested in Section A 2. the most recent report(s) from the Ministry of Health (health statistics and plan of action) 3. the most recent report(s) form the National Cancer Control Programme or alike if such a programme exists We wish to thank you again for your kind aSSistance in providing this important information.

-- 29 --

CANCER DATABASE FOR THE MSTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Appendix 2 - Individual country profiles

COUNTRY/AREA

PAGE

COUNTRY/AREA

PAGE

American Samoa Australia Brunei Darussalam Cambodia China, People's Republic of Cook Islands Fiji French Polynesia Guam Hong Kong. China Japan Kiribati Korea, Republic of Lao People's Democratic Republic Macao Malaysia Mariana Islands. Commonwealth of the Northern Marshall Islands, Republic of the Micronesia, Federated States of

32 35 38 41 44

Mongolia Nauru New Caledonia New Zealand Niue Palau, Republic of Papua New Guinea Philippines Pitcairn Island Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam. Socialist Republic of Wallis and Futuna

88 91

97 100 103 106 109 112 115 118 121 124 127 130 133 136 139

47 50 53 56 59 62 65 68 71 74 77

79 82 85

-- 30 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Appendix 2 - Individual country profiles

COUNTRY/AREA

PAGE

COUNTRY/AREA

PAGE

American Samoa Australia Brunei Darussalam Cambodia China, People's Republic of Cook Islands Fiji French Polynesia Guam Hong Kong, China Japan Kiribati Korea, Republic of Lao People's Democratic Republic Macao Malaysia Mariana Islands, Commonwealth of the Northern Marshall Islands, Republic ofthe Micronesia, Federated States of

32 35 38 41 44 47 50 53 56 59 62 65 68 71 74 77

88 91 94 97 100 103 106 109 112 115 118 121 124 127 130 133 136 139

79 82 85

-- 31 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION; ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

American Samoa

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (In 1000 sq. kin)

0.20 1995 1994 1994 1994 1995 S;;IYIi~

Population 56,500 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age CrUde death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

48.00 38.10 5.40 4.10

gf slulb 1993 first Circulatory system second Respiratory system third Neoplasms fourth Injuries and or Accidents fifth Diabetes

100 1,750

1990 1988

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. hnkinq of five mOlit frequent Cilncem (blInk llble mean Ii no dlta available) Men Women

first second third

fourth fifth

-- 32 .-

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND OATAANALVsls

Questionnaire data of 23/07/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas ~ Hospital based information system

o Ad-hoc sample surveys ~ Official mortality statistics

o Other source

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP ~ LOW priority given

o Cultural, SOCietal or religious factors ~ Shortage of funds

to cancer by MoH

o Cancer not major If yes to above, they also follow WHO guidelines health problem ~ Shortage of

o National or regional sample surveys performed or ~ National or regional sample surveys performed or

ongoing on exposure to known risk factors for cancer

qualified personnel

o Geographical

o Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity;

B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing B B B

Alcohol and/or drug abuse C C C

Sexual education C

Sunlight Occupational exposure hazards A A A B B B

B B C

A C

A national strategic programme for tobacco control exists

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 95% coverage (children < 1yr. of age), as

estimated in 1996

-- 33 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATAANALYSlS

D. Early detection

Ii'! Ii'!

Screening for breast cancer routinely offered to women since 1996 with 52% coverage of target population

o If yes to above, mammography is part of the screening procedures Screening for cervical cancer routinely offered to women since 1996 with 34% coverage of target population

Ii'!

If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer

o Early detection programmes for skin cancer exist Ii'! Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines

fi2I Chemotherapy drugs for cancer treatment generally available

o Internal radiation therapy is available F. Palliative care

o External radiotherapy equipment is available

Ii'! There are well established follow-uP guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100%

o Patients and their families generally know that cancer symptoms can be alleviated

o Families are taught simple methods of home care to alleviate symptoms of cancer pain o Terminal patients receive palliative care at home o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care C Complex prescription procedures Complex reporting to national narcotics board Other barrier

o legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o o o

o Misconception about its side effects (dependency)

Unavailability of drug

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 34 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Australia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

7,682.00 1995 1994 1995 1995 1995 1995 1990 1996 Ci!u:!!il:! 2f s!ei!~b 1995 first Neoplasms second Heart / Cardiovascular third Cerebrovascular fourth CCPD fifth Injuries and or Accidents

Population 18,049,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage

71.50 21.40 11.90 6.90 77.00 95

GNP per capita, SUS 18,128

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking 2f fiv!il m2:!t frequent cancers (blank ti!ble mean:! no data available) Men first second third fourth fifth Prostate Lung Colon/Rectum Melanoma Oral cavity Women Breast Colon/Rectum Melanoma Lung Cervix

-- 35 -I

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 22/09/98 A. Cancer burden Sources of cancer data

Ii?] Nationwide registration of all cases

Ii?] Ad-hoc sample surveys

Il2I

Cancer registry in one or more areas, with coverage of 100% based information system

Il2I Official

mortality statistics

Il2I Hospital

o Other source

B. Aspects of cancer control pOlicy (CCP)

Il2I Focal pOint for coordination of cancer control

activities

Barriers to establishment of CCP

Ii?] Policies have been adopted for a multisectoral effort to manage cancer control activities Since 1997

o Low priority given o Cultural, societal or to cancer by MoH health problem religious factors

Il2I Il2I Il2I

If yes to above, they also follow WHO guidelines

o Cancer not major o Shortage of qualified personnel

o Shortage of funds o Geographical configuration of country

National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Other barrier

Il2I A national Cancer SOCiety or Similar agency exists Il2I Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A ; currently no activity;

8 ; Limited interventions (even if under development or if experimental) C ; established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity C C C Smoking and/or tobacco chewing C C

Alcohol and/or drug abuse C

Sexual education C C

Sunlight Occupational exposure hazards C C C

C C C

C C

Il2I Il2I

A national strategic programme for tobacco control exists Since 1991 legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

-- 36 --

CANCER DATABASE FOR THE ~STERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

ii'I ii'I

Screening for breast cancer routinely offered to women since 1990 with 100% coverage of target population

~ If yes to above, mammography is part of the screening procedures Screening for cervical cancer routinely offered to women since 1991 with 62% coverage of target population !i2llf yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist ~ Primary health care workers are trained in the value of early detection and are in a position to refer patients

for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is 29% The percentage of all cancers diagnosed at an advanced (generally not curable) stage Is not known

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

~ WHO list of essential drugs for cancer chemotherapy has been formally adopted ~ There are well established cancer treatment guidelines

!i2I Extemal

radiotherapy equipment is available

!i2llnternal radiation therapy is available ~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care ~ Patients and their families generally know that cancer symptoms can be alleviated

~ Families are taught simple methods of home care to alleviate symptoms of cancer pain ~ Terminal patients receive palliative care at home ~ A curriculum for training in palliative care has been developed

o Hospitals have adopted WHO guidelines for palliative care o Complex prescription procedures o U Complex reporting to national narcotics board Other barrier

~ Primary health care workers receive training in palliative care

~ legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

Unavailability of drug

l=-:i Misconception about its side effects (dependency)

~ Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

~ There is a national society for palliative care

-- 37 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Brunei Darussalam

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

5.80 1995 1995 1995 1995 1995 1991 1991 1996 !dU!liilli

Population 296,000 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

66.60 33.20 2.90 2.90 75.00 90

gf "~llb

1995

first Injuries and or Accidents second Neoplasms third Heart / Cardiovascular fourth Cerebrovascular fifth Diabetes

GNP per capita, SUS 17,053

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranklnq gf five most frequent clncers (blink table meanli no dig aVlilable) Men first second third fourth fifth Lung liver Colon/Rectum Stomach Nasopharynx Women Breast Cervix Lung Colon/Rectum Ovary

-- 38 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 10/12/98 A. Cancer burden Sources of cancer data

D ~

Nationwide registration of all cases

D Ad-hoc sample surveys

[J Cancer registry in one or more areas Hospital based information system

D Official mortality statistics D Other source

B. Aspects of cancer control policy (CCP)

Focal point for coordination of cancer control activities manage cancer control activities

Barriers to establishment of CCP

D Policies have been adopted for a multi sectoral effort to D D D If yes to above, they also follow WHO guidelines

D D

Low priority given to cancer by MoH Cancer not major health problem qualified personnel

~ Cultural, SOCietal or

religious factors

Shortage of funds Geographical configuration of country

~ Shortage of

Ii2I

Other barrier

D A national Cancer Society or similar agency exists D Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing A A A

Alcohol and/or drug abuse A C A

Sexual education A A A

Sunlight Occupational exposure hazards A A

A A A

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaccination of infants against Hepatitis-B with 95% coverage (children < lyr. of age), as estimated In

Ii2I

-- 39 --

) CANCER DATABASE FOR THE WESTERN PACIFIC REGION; ESSENTIAl FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures IilI Screening for cervical cancer routinely offered to women since 1986, coverage unknown IilI If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist o for Primary health care workers are trained in the value of early detection and are in a position to refer patients diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 1

o External radiotherapy equipment is available o Internal radiation therapy is available F. Palliative care

IilI Chemotherapy drugs for cancer treatment generally available IilI WHO list of essential drugs for cancer Chemotherapy has been formally adopted IilI There are well established cancer treatment guidelines

IilI There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100% ~ Patients and their families generally know that cancer symptoms can be alleviated

o Families are taught simple methods of home care to alleviate symptoms of cancer pain o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO gUidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Terminal patients receive palliative care at home

o Complex prescription procedures

o Complex reporting to national narcotics board o other barrier

o Misconception about its side effects (dependency)

Unavailability of drug

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 40 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL VSIS

Countly/Area

Cambodia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

181.00 1995 1995 1995 1995 1995 1995 1995 1993 !:;iU!I!!!1 of dS:iltb 1995 first Diarrhoea second Pneumonia third Tuberculosis fourth Malaria fifth Injuries and or Accidents

Population 10,200,000 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs

20.70 41.80 2.80 16.60 52.00 35 222

Literacy rate, percentage GNP per capita. SUS

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranklnq of fivs: malt frequent canc!!!rs (blank tab.s: m!!!anl no dilta available> Men first second third fourth fifth Liver Lung Stomach Colon/Rectum Oral cavity Women Cervix Breast Liver Lung Colon/Rectum

-- 41 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 28/01/98 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry In one or more areas ~ Hospital based information system

o Ad-hoc sample surveys o Official mortality statistics o Other source

B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1994

IilI Low priority given to cancer by MoH

o Cultural, societal or religious factors ~ Shortage of funds

~ If yes to above, they also follow WHO guidelines

Cancer not major health problem qualified personnel

o National or regional sample surveys performed or o National or regional sample surveys performed or

IilI Shortage of IilI Other barrier

o Geographical

ongoing on exposure to known risk factors for cancer

configUration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

Lack of budget and specialists.

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A

B C

= Limited interventions (even if under development or if experimental) = established regional or nation-Wide programmes Diet and exercise Smoking and/or tobacco chewing A A A Alcohol and/or drug abuse A A A Sexual education A A A Sunlight Occupational hazards exposure A A A A A A

= currently no activity;

For children and adolescents For the general population For specific target groups Other primary prevention activity

A A A

~ A national strategic programme for tobacco control exists since 1995

o o

Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

-- 42 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL YSIS

D. Early detection

C C C C

Screening for breast cancer routinely offered to women

:::::J If yes to above, mammography is part of the screening procedures Screening for cervical cancer routinely offered to women

C If yes to above,

cytology is part of the screening procedures·

Early detection programmes for oral cancer Early detection programmes for skin cancer exist Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

Ii"I There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 1 C Chemotherapy drugs for cancer treatment generally available

C WHO list of essential drugs for cancer chemotherapy has been formally adopted C There are well established cancer treatment guidelines C External radiotherapy equipment is available C Internal radiation therapy is available

C There are well established follow-up gUidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

Ii"I Patients and their families generally know that cancer symptoms can be alleviated Ii"I Families are taught simple methods of home care to alleviate symptoms of cancer pain Ii"I Terminarpatients receive palliative care at home C A curriculum for training in palliative care has been developed C Primary health care workers receive training in palliative care C Hospitals have adopted WHO guidelines for palliative care C Legislation has been passed to make morphine available for the

treatment of cancer pain. Barriers include:

C C C C

Complex prescription procedures Complex reporting to national narcotics board Other barrier

0 C

Unavailability of drug Misconception about its side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 43 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Counby/Area

China, People's Republic of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (In 1000 sq. km)

9,600.00 1994 1994 1993 1993 1994 1993 1993 1993 S;iUII§1 Rf d!:illb 1993 first Neoplasms second Cerebrovascular third Respiratory system fourth Heart / Cardiovascular fifth Injuries and or Accidents

Population 1,198,500,0 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), Yrs Literacy rate, percentage GNP per capita, $US

26.00 29.30 6.00 6.50 70.00 80 271

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Rf five most freguent cancers (blank table means nR data ayallil ble ) Men first second third fourth fifth Stomach Liver Lung Oesophagus Colon/Rectum Women Stomach Lung Breast Liver Colon/Rectum

•

-- 44 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 03/03/98 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases Cancer registry in one or more areas

D Ad-hoc sample surveys D Official mortality statistics 1990-1992 Mortality survey in China ~ Other source

o Hospital based information system B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1965 ~ If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or

D D D

Low priority given to cancer by MoH Cancer not major health problem Shortage of qualified personnel

D Cultural, societal or religious factors ~ ShOrtage of funds ~ Geographical

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

~ Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

Lack of awareness in general population

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A B A

Smoking and/or tobacco chewing A

Alcohol and/or drug abuse A

Sexual education A

Sunlight Occupational exposure hazards A A

B A

A A

B A

A national strategic programme for tobacco control exists

•

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 60% coverage (children < 1yr. of age), as

estimated in

-- 45 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

Screening for breast cancer routinely offered to women since 1975, coverage unknown

~ ~

If yes to above, mammography is part of the screening procedures

~ Screening for cervical cancer routinely offered to women since 1955 with 10% coverage of target population If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

Ii21 WHO

list of essential drugs for cancer chemotherapy has been formally adopted

~ There are well established cancer treatment guidelines

~ External radiotherapy equipment is available

o Internal radiation therapy is available ~There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Families are taught simple methods of home care to alleviate symptoms of cancer pain DTerminal patients receive palliative care at home ~ A curriculum for training in palliative care has been developed

o Patients and their families generally know that cancer symptoms can be alleViated

~ Primary health care workers receive training in palliative care; the percentage trained is 17%

o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures o other barrier o

Complex reporting to national narcotics board

o Misconception about its side effects (dependency)

Unavailability of drug

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known

o There is a national society for palliative care

The total per capita consumption of morphine is 0 g

-- 46 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES ANO DATA ANIAlYSIS

Country/Area

Cook Islands

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. krn)

0.24 1994 1995 1995 1994 1994 1992 1995 1990 ~i!YIif:1i 2f df:i!l!:l 1995

Population 19,300 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

60.00 34.00 8.00 6.00 69.00 100 4,113

first Circulatory system second Neoplasms third Respiratory system fourth Diabetes fifth Injuries and or Accidents

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq of five most frequent cancers (blank table means no data available) Men

Women

first second

third fourth

fifth

-- 47 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 31/07/97 A. Cancer burden Sources of cancer data

o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP)

fill

Nationwide registration of all cases

o Ad-hoc sample surveys o Official mortality statistiCs o Other source

o Focal pOint for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP

fill C

Low priority given to cancer by MoH Cancer not majOr health problem Shortage of qualified personnel

~ Cultural, societal or

religious factors

If yes to above, they also follow WHO guidelines

fill

Shortage of funds

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

fill

~ Geographical

o National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Other barrier

configuration of country

o A national Cancer Society or Similar agency exists ~ Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A B C

= currently no activity; = Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing C C

Alcohol and/or drug abuse C C

Sexual education C C C

Sunlight Occupational hazards exposure A A A

For children and adolescents For the general population For specific target groups Other primary prevention activity

C C

A A A

fill fill fill

A national strategic programme for tobacco control exists since Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaccination of infants against Hepatitis-B with 95% coverage (children < 1yr. of age), as estimated in 1997

-- 48 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND OATAANAL YSIS

D. Early detection

o Screening for breast cancer routinely offered to women U If yes to above. mammography is part of the screening procedures ~

Screening for cervical cancer routinely offered to women

IilI If yes to above. cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist

o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is 50% The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment [J There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o Chemotherapy drugs for cancer treatment generally available o External radiotherapy equipment is available o Internal radiation therapy is available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines

~ There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care

IilI Patients and their families generally know that cancer symptoms can be alleviated IilI Families are taught simple methods of home care to alleViate symptoms of cancer pain ii'!Terminal'patients receive palliative care at home

Ll A curriculum

for training in palliative care has been developed in palliative care

o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers Include: :=: Complex prescription procedures Cl iJ Other barrier

D Primary health care workers receive training

[j Unavailability of drug

Complex reporting to national narcotics board

Misconception about its Side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 25% The total per capita consumption of morphine is not known [] There is a national society for palliative care

-- 49 -I

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

Country/Area

Fiji

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

18.30 1996 1995 1996 1996 1994 1995 1995 1993 ~YIU 2( d!li!tb 1995

Population 769,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

40.70 33.80 4.00 5.60 72.60 92 1,555

first Circulatory system second Infectious and parasitic third Neoplasms fourth Respiratory system fifth Endocrine and metabolic

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five m2st (requent cancers (blank table means no data ayallable) Men first second third fourth fifth Liver Colon/Rectum Prostate Lung Stomach Women Cervix Breast Colon/Rectum Ovary Lung

-- 50 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 21/08/98 A. Cancer burden Sources of cancer data ~ Nationwide registration of all cases ~ Cancer registry in one or more areas ~ Hospital based information system

o Ad-hoc sample surveys ~ Official mortality statistics ~ Other source

Death registry and hospital discharge data

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities ~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1995 ~ If yes to above, they also follow WHO guidelines

Barriers to establishment of CCP ~ Low priority given ~ Cultural, societal or

to cancer by MoH

religious factors ~ Shortage of funds ~ Geographical

o Cancer not major health problem ~ Shortage of

o National or regional sample surveys performed or ~ National or regional sample surveys performed or

ongoing on exposure to known risk factors for cancer

qualified personnel ~ Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

Policy for various stages of programme with appropriate budget

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A 8 B

Smoking and/or tobacco chewing B B B

Alcohol and/or drug abuse B 8 8

sgxual ed cation B B 8

Sunlight Occupational exposure hazards A A A

B 8 8

o o

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed

~ There is routine vaccination of infants against Hepatitis-B with 98% coverage (children < 1yr. of age), as estimated in 1997

-- 51 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women

o If yes to above, mammography is part of the screening procedures Ii2I Screening for cervical cancer routinely offered to women since 1976, coverage unknown

Ii2I If yes to above, cytology is part of the screening procedures

E. Treatment DThere are comprehensive cancer centres specialized in diagnosis and treatment of cancer

Ii2I Chemotherapy drugS for cancer treatment generally available Ii2I WHO list of essential drugs for cancer chemotherapy has been formally Ii2I There are well established cancer treatment guidelines

adopted

o Extemal radiotherapy equipment is available

There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

~ Intemal radiation therapy is available

F. Palliative care

Ii2I Patients and their families

generally know that cancer symptoms can be alleviated

fii'j Families are taught simple methods of home care to alleviate symptoms of cancer pain

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care ~ Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers Include:

U Terminal patients receive palliative care at home

[] Complex prescription procedures

r::::J Unavailability of drug

r::::J Complex reporting to national narcotics board [] Other barrier

o Misconception about its side effects (dependency)

fii'j Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is 100% The total per capita consumption of morphine is 318 g

fii'j There is a national society for palliative care

-- 52 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Country/Area

French Polynesia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

4.17 1995 1995 1995 1995 1994 1994 1988 1995 !:;iU!!Ii!i!!Ii

Population 220,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

55.00 35.20 3.40 4.80 70.60 90

!If ~!i!it!:! 90-93 first Circulatory system second Neoplasms third Respiratory system fourth Injuries and or Accidents fifth Infectious and parasitic

GNP per capita, $US 14,770

Data on cancer inCidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rinkinq of five most frequent cancers (blink table means n!l data iViilible) Men first second third fourth fifth Women

-- 53 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 04/11/97 A. Cancer burden Sources of cancer data ~ Nationwide registration of all cases

D Ad-hoc sample surveys ~ Official mortality statistics

D Cancer registry in one or more areas D Hospital based information system

D Other source

B. Aspects of cancer control policy (CCP)

D D

Focal point for coordination of cancer control activities Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP ~ Low priority given

D D D

to cancer by MoH

Cultural, societal or religious factors Shortage of funds Geographical configuration of country

D If yes to above, they also follow WHO guidelines

Cancer not major health problem Shortage of qualified personnel

~ National or regional sample surveys performed or

ongoing on exposure to known risk factors for cancer

D National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

D Other barrier

D D

A national Cancer Society or Similar agency exists Systematic evaluation of the progress made in cancer control

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing C C C

Alcohol and/or drug abuse C C C

Sexual education C B B

Sunlight Occupational hazards exposure A A A A A A

B B B

A national strategic programme for tobacco control exists

~ Legislation regulating tobacco sales/advertismentjsmoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 78% coverage (children

< lyr. of age), as

estimated in 1996

-- 54 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women '-.J If yes to above, mammography is part of the screening procedures

o Screening for cervical cancer routinely offered to women o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist

o If yes to above, cytology is part of the screening procedures

~ Primary health care workers are trained in the value of early detection and are in a position to refer patients

for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

D There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted ~ There are well established cancer treatment guidelines

o External radiotherapy equipment is available c:; Internal radiation therapy is available ~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care [J Patients and their families generally know that cancer symptoms can be alleviated

C Families are taught simple methods of home care to alleViate symptoms of cancer pain Ii2I Terminal patients receive palliative care at home; the percentage of terminal patients that do Is

10%

D A curriculum for training in palliative care has been developed D Primary health care workers receive training in palliative care D Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

i'I

Complex prescription procedures

0 Unavailability of drug Misconception about its side effects (dependency) Complex reporting to national narcotics board Other barrier Lack of training in palliative care; unsuitable family structure

:;jj Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

D There

is a national society for palliative care

-- 55 --

CANCER DATABASE FOR TliE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

CountrylArea

Guam

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.54 1994 1994 1990 1990 1992 1992 1983 1986 till!lH

Population 146,700 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes). yrs Literacy rate. percentage GNP per capita, $US

38.00 33.30 5.80 9.00 74.00 96 9,175

gf dtmtb 1993 first Heart / Cardiovascular second Diabetes third Circulatory system fourth Injuries and or Accidents fifth Neoplasms

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most freguent cancers (blank table means no data available) Men first second third fourth fifth Lung Prostate Colon/Rectum Liver Larynx Women Breast Lung Cervix Uterus Colon/Rectum

-- 56 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND OATAANALVSIS

Questionnaire data of 22/09/97 A. Cancer burden Sources of cancer data

o fiiil

Nationwide registration of all cases Cancer registry in one or more areas

o Ad-hoc sample surveys fiiil Official mortality statistics

o Hospital based information system B. Aspects of cancer control policy (CCP)

o Other source

o Focal point for coordination of cancer control activities o Policies have been adopted for a multi sectoral effort to manage cancer control activities

Barriers to establishment of CCP

o o fiiil

Low priority given to cancer by MoH Cancer not major health problem Shortage of qualified personnel

o fiiil

Cultural, societal or religious factors Shortage of funds

o If yes to above, they also follow WHO guidelines [] National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

LJ Geographical configuration of country

fiiil

National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Other barrier

fiiil A national Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A = currently no activity; B = Limited interventions (even if under development or if experimental) C = establishedregional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity B

Smoking and/or tobacco chewing C B

Alcohol and/or drug abuse C C

Sexual education C B C

Sunlight Occupational exposure hazards B B

A B B

B B

:::J

A national strategic programme for tobacco control exists

~ Legislation regulating tobacco sales/advertisment!smoking has been passed

IiiII There is routine vaccination of infants against Hepatitis-B with estimated in

% coverage (children < lyr. of age), as

-- 57 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND DATA ANAlYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1985, coverage unknown ~ If yes to above, mammography is part of the screening procedures

Ii2I

Screening for cervical cancer routinely offered to women since 1970 with 70% coverage of target population

~ If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer ~ Early detection programmes for skin cancer exist

~ Primary health care workers are trained in the value of early detection and are in a position to refer patients

E. Treatment

Ii2I There are comprehensive cancer centres specialized

in diagnosis and treatment of cancer in the number of 1

~ Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted Ii2I There are well established cancer treatment guidelines [ii'I External radiotherapy equipment is available in the number of 1 radiotherapy machine(s) [ii'I Internal radiation therapy is available ~ There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

Ii'! Patients and

their families generally know that cancer symptoms can be alleviated

~ Families are taught simple methods of home care to alleviate symptoms of cancer pain

Ii2I Terminal

patients receive palliative care at home; the percentage of terminal patients that do is 10%

o A curriculum for training in palliative care has been developed ~ Primary health care workers receive training in palliative care; the percentage trained is 90%

o Hospitals have adopted WHO guidelines for palliative care Ii<'i Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures o Complex reporting to national narcotics board o Other barrier D Morphine is available at the Primary Health Care level The total per capita consumption of morphine is not known

n Misconception about its side effects (dependency)

Unavailability of drug

The percentage of terminal cancer patients receiving morphine is not known

Ii<'i

There is a national society for palliative care

-- 58 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES ANa DATA ANAL VSIS

Country/Area

Hong Kong, China

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

1.10 1994 1994 1994 1994 1994 1994 1994 1994 CaYli!!illi! 2t d!:ilt!J 1994 first Neoplasms second Heart / Cardiovascular third Cerebrovascular fourth Pneumonia fifth Injuries and or ACCidents

Population 6,061,400 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

95.70 19.40 9.40 5.00 89

GNP per capita, SUS 21,680

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq of five most frequent canc!ilrli! (blank tabl!: means no data ilvailable) Men first second third fourth fifth Lung Liver Colon/Rectum Nasopharynx Stomach Women Breast Lung Colon/Rectum Cervix Stomach

-- 59 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSE~TIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 05/02/98 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases ~ Cancer registry in one or more areas, with coverage of 100% ~ Hospital based information system

~ Ad-hoc sample surveys

~ Official mortality statistics

[j Other source

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities ~ Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP

Low priority given to cancer by MoH health problem

~ Cultural, societal or

religious factors

o Cancer not major If yes to above, they also follow WHO guidelines

o Shortage of funds o Geographical configuration of country

~ National or regional sample surveys performed or

o Shortage of C

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

qualified personnel Other barrier

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A

= currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing C C C

Alcohol and/or drug abuse C B C

Sexual education C C C

Sunlight Occupational exposure hazards A A A A B C

For children and adolescents For the general population For specific target groups Other primary prevention activity

C B C

~ A national strategic programme for tobacco control exists since ~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with % coverage (children < 1yr. of age), as esti mated in

-- 60 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women

~ If yes to above, mammography is part of the screening procedures ~

Screening for cervical cancer routinely offered to women since 1973, coverage unknown

~ If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist ~ Primary health care workers are trained in the value of early detection and are in a position

to refer patients

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 5 ~ Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted ~ There are well established cancer treatment guidelines

~ External radiotherapy equipment is available ~ Internal radiation therapy is available ~ There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care ~ Patients and their families generally know that cancer symptoms can be alleviated ~ Families are taught simple methods of home care to alleviate symptoms of cancer pain ~ Terminal

patients receive palliative care at home

~ A curriculum for training in palliative care has been developed

o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care

o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures o Complex reporting to national narcotics board o Other barrier 0 Unavailability of drug

o Misconception about its side effects (dependency)

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 61 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Japan

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

377.80 1994 1994 1994 1994 1994 1994 1993 1994 !;;III!!!:!!!

Population 125,033,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage

77.20 16.30 14.10 7.10 79.00 100

Qf d!:!lt!!

1993

first Neoplasms second Heart / Cardiovascular third Cerebrovascular fourth Pneumonia fifth Injuries and or Accidents

GNP per capita, SUS 37,925

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of flv!:! mOH fr!:!all!:!nt clnql'l! (blank table m!:!ID!! DO data ayailabl!:!) Men first second third fourth fifth Stomach Colon/Rectum Lung Liver Pancreas Women Stomach Breast Colon/Rectum Lung Cervix

-- 62 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 16/06/98 A. Cancer burden Sources of cancer data

Nationwide registration of all cases coverage of 13%

o Ad-hoc sample surveys ii2i Official mortality statistics

~ Cancer registry in one or more areas, with

ii2i Hospital

based information system

o other source

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP

Low priority given to cancer by MoH health problem

o o

Cultural, societal or religious factors Shortage of funds

o Cancer not major If yes to above, they also follow WHO guidelines

~ National or regional sample surveys performed or

o Shortage of qualified personnel

o Geographical

ongoing on exposure to known risk factors for cancer

LJ National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

ii2i

Other barrier Legislation not established; emphasis on secondary prevention; no monitoring of cancer control ..

configuration of country

1-- Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A B currently no activity; Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes ~ ~

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A B A

Smoking and/or tobacco chewing A B A

Alcohol and/or drug abuse A B A

Sexual education A A A

Sunlight Occupational exposure hazards A A A A A B

"L, A national strategic programme for tobacco control exists since 1995

Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

-- 63 --

CANCER DATABASE FOR THE v.1OSTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1987 with 8% coverage of target population

If yes to above, mammography is part of the screening procedures

~ Screening for cervical cancer routinely offered to women since 1983 with 15% coverage of target population

. ~ If yes to above, cytology is part of the screening procedures

D D

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 30 ~ Chemotherapy drugs for cancer treatment generally available

C WHO list of essential drugs for cancer chemotherapy has been formally adopted I:::J There are well established cancer treatment guidelines ~ External radiotherapy equipment is available ~ Internal radiation therapy is available

n There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care

D ~

Patients and their families generally know that cancer symptoms can be alleviated Terminal patients receive palliative care at home; the percentage of terminal patients that do is 5% for training in palliative care has been developed palliative care

L Families are taught simple methods of home care to alleviate symptoms of cancer pain

D A curriculum

D Primary health care workers receive training in

~ Hospitals have adopted WHO guidelines for palliative care; the percentage of hospitals that have is 50% ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

D D

Complex prescription procedures Complex reporting to national narcotics board

[J Unavailability of drug ~ Misconception about its side effects (dependency)

~ other barrier Physicians' low interest in pall. Care due to no curriculum in medical schools.

~ Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 50% The total per capita consumption of morphine is 892 Total Kg

IiiIl There is a national society for palliative care

-- 64 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Kiribati

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.81 1995 1990 1995 1995 1990 1995 1990 1994 !:;jlysei of d~al!l 1995 first Senility second Heart / Cardiovascular third Digestive system fourth Liver diseases fifth Non-communicable diseases

Population 77,800 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11 DOD Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

34.80 41.00 5.10 9.20 60.20 90 740

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most fregyent cjlncers (blank table means no data availjlble) Men first second third fourth fifth Women

-- 65 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Questionnaire data of 11/09/97 A. Cancer burden Sources of cancer data

Ii'J

Nationwide registration of all cases

[J Ad-hoc sample surveys

[J Cancer registry in one or more areas

Ii'J Official

mortality statistics

Ii'J Hospital

based information system

i Other source

B. Aspects of cancer control policy (CCP)

LJ C

Focal point for coordination of cancer control activities Policies have been adopted for a multisectDral effort to manage cancer control activities

Barriers to establishment of CCP

Low priority given to cancer by MoH Cancer not major health problem Shortage of qualified personnel Other barrier

Ii'J Ii'J Ii'J

Cultural, societal or religious factors Shortage of funds Geographical configuration of country

o D

D If yes to above, they also follow WHO guidelines

National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer ongoing on knowledge, attitudes and practices (KAP) on various life-styles

Ii'J

::J National or regional sample surveys performed or D A national Cancer Society or similar agency exists

r::::

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A B C

= currently no activity; = Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing A A B Alcohol and/or drug abuse A A A Sexual education A C B

Sunlight Occupational exposure hazards A A A A A A

For children and adolescents For the general population For specific target groups

C A C

Other primary prevention activity

o D Ii'J

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaCCination of infants against Hepatitis-B with 66% coverage (children < 1yr. of age), as estimated in 1996

-- 66 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection D Screening for breast cancer routinely offered to women ~

If yes to above, mammography is part of the screening procedures

D Screening for cervical cancer routinely offered to women D If yes to above, cytology is part of the screening procedures D Early detection programmes for oral cancer D Early detection programmes for skin cancer exist D Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment DThere are comprehensive cancer centres specialized in diagnosis and treatment of cancer D Chemotherapy drugs for cancer treatment generally available D WHO list of essential drugs for cancer chemotherapy has been formally adopted D There are well established cancer treatment guidelines D External radiotherapy equipment is available D Internal radiation therapy is available D There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

[1 Patients and

their families generally know that cancer symptoms can be alleviated

D Families are taught simple methods of home care to alleviate symptoms of cancer pain

o A curriculum for training in palliative care has been developed D Primary health care workers receive training in palliative care D Hospitals have adopted WHO guidelines for palliative care D Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: [] Complex prescription procedures ~1 Complex reporting to national narcotics board

[l Terminal patients receive palliative care at home

Unavailability of drug

'-- Misconception about its side effects (dependency)

Other barrier D Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

[J There is a national society for palliative care

-- 67 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Korea, Republic of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

99.40 1995 1995 1995 1995 1994 1994 1995 1995 i:aYi!:i Qf !!eiltb 1995 first Cerebrovascular second Injuries and or Accidents third Heart / Cardiovascular fourth Liver diseases fifth Neoplasms

Population 45,093,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage

78.50 23.40 5.90 5.40 71.00

98 GNP per capita, $US 10,076

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq Qf five mos frequent cancers (blank table meilni nQ data ilvailable) Men first second third fourth fifth Stomach Lung Liver Colon/Rectum Bladder Women Cervix Stomach Breast Colon/Rectum Liver

-- 68 --

CANCER DATABASE FOR THE m;STERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Questionnaire data of 16/10/97 A. Cancer burden Sources of cancer data

CJ CJ

Nationwide registration of all cases Cancer registry in one or more areas

o Ad-hoc sample surveys [l Official mortality statistics

~ Hospital based information system

o Other source

B. Aspects of cancer control policy (CCPJ ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1996 ~ If yes to above, they also follow WHO guidelines

o Low priority given o to cancer by MoH

Cultural, societal or religious factors

o Cancer not major health problem

~ Shortage of funds

o National or regional sample surveys performed or o National or regional sample surveys performed or

o Shortage of

ongoing on exposure to known risk factors for cancer

qualified personnel

o Geographical

o Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAPlon various life-styles ~ A national Cancer Society or similar agency exists ~ Systematic evaluation of the progress made in cancer control

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing A B A

Alcohol and/or drug abuse A B A

Sexual education B A A

Sunlight Occupational exposure hazards A B A A A B

A B A

~ A national strategic programme for tobacco control exists since 1988

~ Legislation regulating tobacco sales/advertisment/smoking has been passed

Routine vaccination of infants against Hepatitis-B

-- 69--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection illI Screening for breast cancer routinely offered to women since 1996, coverage unknown illIlf yes to above, mammography is part of the screening procedures lillI Screening for cervical cancer routinely offered to women since 1996, coverage unknown lillIlf yes to above, cytology is part of the screening procedures

LJ C

Early detection programmes for oral cancer

o Early detection programmes for skin cancer exist Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment illI There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 130

Ii'] Chemotherapy drugs for cancer treatment generally available L.: WHO list of essential drugs for cancer chemotherapy has been formally adopted

~ There are well established cancer treatment guidelines

~ External radiotherapy equipment is available in the number of 80 radiotherapy machine(s)

lillIlnternal radiation therapy is available illI There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care lillI Patients and their families generally know that cancer symptoms can be alleviated

ii2I Families are taught simple ~ Terminal

methods of home care to alleviate symptoms of cancer pain

patients receive palliative care at home

o A curriculum for training in palliative care has been developed I i Primary health care workers receive training in palliative care

C Hospitals have adopted

WHO guidelines for palliative care

illI Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures [J Complex reporting to national narcotics board L;

o Misconception about its side effects (dependency)

Unavailability of drug

Other barrier

illI Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 70 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Lao People's Democratic Republic

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. kin)

236.80 1996 1995 1996 1996 1990 1995 1992 1995 ~aY!U:i gf d!i:i!!l:b

Population 5,023,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita. SUS

21.70 44.80 3.00 15.20 51.00 60 280

1990

first Malaria second Pneumonia third Meningitis fourth Diarrhoea fifth Tuberculosis

bata on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ri!!nkina of five mgsl: fr!i:aY!i:nl: ci!!ncers (blank ti!!bl!i: m!i:ans no di!!ta i!!vaili!!blel Men first second third fourth fifth Liver Lung Colon/Rectum Stomach Leukaemia Women Cervix Breast Oral cavity Liver Lung

-- 71 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND OATAANIALVSIS

Questionnaire data of A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system

o Ad-hoc sample surveys o Official mortality statistics o Other source

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP

o o

Low priority given to cancer by MoH health problem Shortage of qualified personnel

Cultural, societal or religious factors

o Cancer not major If yes to above, they also follow WHO guidelines

o Shortage of funds o Geographical configuration of country

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

o National or regional sample surveys performed or

o Other barrier

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o A national Cancer Society or similar agency exists o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A B C

= currently no activity;

= Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing Alcohol and/or drug abuse Sexual education Sunlight Occupational exposure hazards

For children and adolescents For the general population For specific target groups Other primary prevention activity

[J A national strategic programme for tobacco control exists

o o

Legislation regulating tobacco sales/advertisment!smoking has been passed Routine vaccination of infants against Hepatitis-B

-- 72 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women U

If yes to above, mammography is part of the screening procedures

o Screening for cervical cancer routinely offered to women U If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer

o Early detection programmes for skin cancer exist o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment DThere are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o Chemotherapy drugs for cancer treatment generally available o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines o External radiotherapy eqUipment is available o Internal radiation therapy is available o There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated o Families are taught sImple methods of home care to alleVIate symptoms of cancer pain

DTerminal patients receive palliative care at home

[J A curriculum for training in palliative care has been developed 1"1 Primary health care workers receive training in palliative care

o Hospitals have adopted WHO guidelines for palliative care n legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

D Complex prescription procedures ;] Complex reporting to national narcotics board

[J [J

Unavailability of drug Misconception about its side effects (dependency)

'1 Other barrier

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known

o There is a national society for palliative care

The total per capita consumption of morphine is not known

-- 73 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Macao

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.02 1995 1995 1995 1995 1995 1991 1991 1994 !::aus!:ll! of death 1995 first Heart / Cardiovascular second Neoplasms third Cerebrovascular fourth Senility fifth Renal

Population 424,400 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

100.00 25.00 7.30 3.20 69.80

90 GNP per capita, $US 16,164

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of fiv!:l most fr!:lguent cancers (blank table means no data available) Men first second third fourth fifth

Women

-- 74 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of A. Cancer burden

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP) ~

Sources of cancer data

o Ad-hoc sample surveys o Official mortality statistics o Other source

Focal point for coordination of cancer control activities manage cancer control activities

Barriers to establishment of CCP

o Policies have been adopted for a multisectoral effort to o If yes to above, they also follow WHO guidelines

o Low priority given o Cultural, societal or to cancer by MoH religious factors [] Cancer not major health problem [] Shortage of qualified personnel

o National or regional sample surveys performed or o National or regional sample surveys performed or

o Shortage of funds o Geographical configuration of country

ongoing on exposure to known risk factors for cancer

o other barrier

ongoing on knowledge, attitudes and practices (KAP) on various life-styles [] A national Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity Smoking and/or tobacco chewing Alcohol and/or drug abuse

Sexual education

Sunlight Occupational hazards exposure

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

o o

-- 75 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION" ESSENTIAL FEATURES AND OATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women C If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women

o If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist L Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment .1 There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o Chemotherapy drugs for cancer treatment generally available o WHO list of essential drugs for cancer chemotherapy has been formally adapted o There are well established cancer treatment guidelines o External radiotherapy equipment is available C] Internal radiation therapy is available established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

C There are well

F. Palliative care ~

Patients and their families generally know that cancer symptoms can be alleviated

[j Families are taught simple methods of home care to alleviate symptoms of cancer pain

o Terminal patients receive palliative care at home

o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care

n A curriculum for training in palliative care has been developed

o legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures 0 Unavailability of drug o Complex reporting to national narcotics board o Misconception about its side effects (dependency) L Other barrier

Morphine is available at the Primary Health Care level

The percentage of tenninal cancer patients receiving morphine is not known

o There is a national society for palliative care

The total per capita consumption of morphine is not known

-- 76 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND DATA ANALYSIS

Country/Area

Malaysia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

329.80 1996 1994 1994 1994 1996 1994 1991 1994 Causes of death 1994 first Heart / Cardiovascular

Population 21,169,000 Percentage living in urban area Percentage less than 15 years ·of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

54.10 35.80 3.80 4.60 72.00 B5

second Neoplasms third Cerebrovascular fourth Perinatal fifth Injuries and or Accidents

3,590

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq of five most frequent cancers (blank table means Men first second third fourth fifth Lung Colon/Rectum Stomach Liver Nasopharynx '10

data avaifable) Women Breast Colon/Rectum Cervix Lung Ovary

-- 77 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND OATA ANALYSIS

Questionnaire data of 22/10/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases ilt'l Cancer registry in one or more areas, with coverage of 30% .~ Hospital based information system

~ Ad-hoc sample surveys ~ Official mortality statistics

CJ Other source

B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1988 ~ If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or

CJ ~

Low priority given to cancer by MoH Cancer not major health problem qualified personnel

u C

Cultural, societal or religious factors Shortage of funds Geographical configuration of country

~ Shortage of

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

o Other barrier

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A nationai Cancer Society or similar agency exists

~ Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A = currently no activity; 8 = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing C C C

Alcohol and/or drug ·abuse C C C

Sexual education B

Sunlight Occupational exposure hazards A A C C C C

C C

~ A national strategic programme for tobacco control exists since 1993 :-] Legislation regulating tobacco sales/advertisment/smoking has been passed ~

There is routine vaccination of infants against Hepatitis-B with 91% coverage (children < 1yr. of age), as estimated in 1995

-- 78 --

CANCER DATABASE FOR THE\VESTERN PACIFIC REGION: ESSENTIAL FEATURES AND

DATA ANAlYSIS

D. Early detection

~ Screening for breast cancer routinely offered to women since 1985 with 60% coverage of target population ' i If yes to above, mammography is part of the screening procedures ~

o If yes to above, cytology is part of the screening procedures M Early detection programmes for oral cancer M Early detection programmes for skin cancer exist

Screening for cervical cancer routinely offered to women since 1980 with 70% coverage of target population

~ Primary health care workers are trained in the value of early detection and are in a pOsition to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is 30% The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 70%

E. Treatment ~ There are comprehensive cancer centres speCialized in diagnosis and treatment of cancer in the number of 7 ~ Chemotherapy drugs for cancer treatment generally available ~ WHO list of essential drugs for cancer chemotherapy has been formally adopted ~ There are well established cancer treatment guidelines

li2I External radiotherapy equipment is available in the li2I Internal radiation therapy is available ~ There are we!1 established follow-up guidelines

number of 7 radiotherapy machine(s)

The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care

"i2l Patients and their families generally know that cancer symptoms can li2I Terminal

be alleviated

I~ Families are taught simple methods of home care to alleviate symptoms of cancer pain

patients receive palliative care at home; the percentage of terminal patients that do is 20%

o Primary health care workers receive training in paliiative care o

[~A curriculum for training in palliative care has been developed

li2I Hospitals have adopted WHO guidelines for palliative care; the percentage of hospitals that have is 80% CJ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: C Complex prescription procedures 1_ Unavailability of drug

o Other barrier

Complex reporting to national narcotics board

[J Misconception about its side effects (dependency)

U Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

S2I There is a national SOCiety for palliative care

-- 79 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Mariana Islands, Commonwealth of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (In 1000 sq. km)

0.46 1995 1994 1992 1992 1995 1995 1990 1990 Causes of death

Population 59,900 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

28.00 26.00 1.60 2.80 68.10

1995

first Neoplasms second Pneumonia third fourth fifth Cerebrovascular Heart

Cardiovascular

99 GNP per capita, $US 17,459

Respiratory system

-- 80 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 15/10/97 A. Cancer burden Sources of cancer data ~: Nationwide registration of all cases

Ad-hoc sample surveys

!:::J

Cancer registry in one or more areas

~ Official mortality statistics

~ Hospital based information system

:J Other source

B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP [] Low priority given to cancer by MoH

== Policies have been adopted for a multi sectoral effort to manage cancer control activities

o Cultural, societal or religious factors ~ Shortage of funds

If yes to above, they also follow WHO guidelines

LJ Cancer not major health problem ~ Shortage of

[] National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

qualified personnel

o Geographical configuration of country

[J National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

[ii' Other barrier Lack of developed public health infrastructure

IJ A national Cancer Society or similar agency exists :::J Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; 8 = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For Children and adolescents For the general population For specific target groups Other primary prevention activity B B B

Smoking and/or tobacco chewing B B B

Alcohol and/or drug abuse B B B

Sexual education

Sunlight Occupational exposure hazards

C B C

A A

r-:::

A national strategic programme for tobacco control exists

[~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 98% coverage (children < 1yr. of age), as

estimated in 1996

-- 81 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL YSIS

D. Early detection

Ii2I ~

Screening for breast cancer routinely offered to women

~ If yes to above, mammography is part of the screening procedures Screening for cervical cancer routinely offered to women

~ If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer [] Early detection programmes for skin cancer exist ~~ Primary health care workers are trained in the value of early detection and are in a position to refer patients

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available ~' WHO list of essential drugs for cancer chemotherapy has been formally adopted

[J There are well established cancer treatment guidelines

External radiotherapy equipment is available

[] Internal radiation therapy is available

Ii2I There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100% F. Palliative care [J Patients and their families generally know that cancer symptoms can be alleviated

'CJ Families are taught simple methods of home care to alleviate symptoms of cancer pain

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care [] Hospitals have adopted WHO guidelines for palliative care

C Terminal

patients receive palliative care at home

Ii2I Legislation

has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures o Complex reporting to national narcotics board o Other barrier ~ Morphine is available at the Primary Health Care level

[J Unavailability of drug [] Misconception about its side effects (dependency)

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 82 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Marshall Islands, Republic of the

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.18 1995 1994 1993 1993 1993 1994 1988 1995 Causes of deil!h 1993 first Pneumonia second Septicemia third Neoplasms fourth Heart / Cardiovascular fifth Cerebrovascular

Population 56,200 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

65.00 50.90 2.90 4.00 62.80 91 1,850

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most frequent cancers (blank table means no datil available) Men first second third fourth fifth Women

-- 83 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of A. Cancer burden

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP)

Sources of cancer data

o Ad-hoc sample surveys o Official mortality statistics

o other source Barriers to establishment of CCP

o Focal point for coordination of cancer control activities o Policies have been adopted for a multi sectoral effort to manage cancer control activities

o If yes to above, they also follow WHO guidelines u National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Low priority given o Cultural, societal or to cancer by MoH religious factors o Cancer not major [] Shortage of funds hea Ith problem o Shortage of o Geographical qualified personnel

o National or regional sample surveys performed or

o Other barrier

configuration of country

o A national Cancer Society or similar agency exists C Systematic evaluation of the progress made in cancer control

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing

Alcohol and/or drug abuse

Sexual education

Sunlight Occupational exposure hazards

o o o

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

-- 84 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection [J Screening for breast cancer routinely offered to women

':J

If yes to above, mammography is part of the screening procedures

n Screening for cervical cancer routinely offered to women [J If yes to above, cytology is part of the screening procedures [J Early detection programmes for oral cancer [J Early detection programmes for skin cancer exist

=: Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment i~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer Chemotherapy drugs for cancer treatment generally available

LJ WHO

list of essential drugs for cancer chemotherapy has been formally adopted

o External radiotherapy equipment is available n Internal radiation therapy is available LJ There are

[J There are well established cancer treatment guidelines

well established follow-up guidelines IS

The percentage of patients diagnosed with curable cancer who receive treatment

not known

F. Palliative care [J Patients and their families generally know that cancer symptoms can be alleviated

D Families are taught simple methods of home care to alleViate l_~ Terminal

symptoms of cancer pain

patients receive palliative care at home

~ A curriculum for training in palliative care has been developed

LJ Primary health care workers receive training in palliative care L Hospitals have adopted WHO guidelines for palliative care C Legislation has been passed to make morphine available for the treatment of cancer pain.

Barriers include:

o Complex prescription procedures J

Unavailability Df drug :_ Misconception about its side effects (dependency)

Complex reporting to national narcotics board Other barrier

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known ;:-: There is a national society for palliative care

-- S5 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Micronesia, Federated States of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.70 1994 1990 1990 1990 1994 1994 1991 1994 ~iI I!I~I of

Population 105,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

59.70 46.10 3.60 7.90 64.00 50 1,890

Iffililth 1991 first Circulatory system

second Respiratory system third Neoplasms fourth Endocrine and metabolic

fifth Injuries and or Accidents

-- 86 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Questionnaire data of 19/08/97 A. Cancer burden Sources of cancer data

Nationwide registration of all cases

[] Ad~hoc sample surveys

[J Cancer registry in one or more areas ~ Hospital based information system

[J Official mortality statistics fiij Other source Death Registry

B. Aspects of cancer control policy (CCP)

Focal point for coordination of cancer control activities manage cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to

[J Low priority given to cancer by MoH

[J Cultural, societal or religious factors ~ Shortage of funds

[J Cancer not major [J If yes to above, they also follow WHO guidelines [J National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer health problem

fiij Shortage of qualified personnel

[J Geographical configuration of country

[J National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

iili

Other barrier Lack of support and guidance

[J A national Cancer Society or similar agency exists [J Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or C = established regional or nation-wide programmes jf

experimental)

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing A A

Alcohol and/or drug abuse A

Sexual education

Sunlight Occupational exposure hazards A

A A

ill! ~

A national strategic programme for tobacco control exists since 1995

~ Legislation regUlating tobacco sales/advertisment/smoklng has been passed

There is routine vaccination of infants against Hepatitis-b with % coverage (chlidren < 1yr. IJf age), estimated in

·55

-- 87 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures ~

Screening for cervical cancer routinely offered to women since 1986, coverage unknown

o If yes to above, cytology is part of the screening procedures

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer o Chemotherapy drugs for cancer treatment generally available LJ WHO list of essential drugs for cancer chemotherapy has been formally adopted [J There are well established cancer treatment guidelines

::J External

radiotherapy equipment is available

o There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

C Internal radiation therapy is available

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated C Terminal I

[] Families are taught simple methods of home care to alleviate symptoms of cancer pain patients receive palliative care at home dev~loped

i A curriculum for training in palliative care has been

[J Primary health care workers receive training in palliative care [j Hospitals have adopted WHO guidelines for palliative care

o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures 0 Unavailability of drug o Misconception about its side effects (dependency) o Complex reporting to national narcotics board U Other barrier

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known

o There is a national society for palliative care

The total per capita consumption of morphine is not known

-- 88 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION; ESSENTIAL FEATURES AND OATAANALYSIS

Country/Area

Mongolia

Data from Country Health Information Profiles, 1991 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

1,566.50 1995 1995 1995 1995 1995 1994 1995 1995 Caus~s of death

Population 2,312,800 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

55.00 38.00 3.80 7.30 62.00 97 327

1995

first Circulatory system second Neoplasms third Respiratory system

fourth Injuries and or Accidents fifth Digestive system

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq of five most frequent cancers (blank table means no data available) Men first second third fourth fifth Stomach Liver Lung/Bronchus(Trachea Oesophagus Colon/Rectum Women Stomach Breast liver Oesophagus lung

-- 89 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 23/09/97 A. Cancer burden Sources of cancer data

I)i!j Nationwide registration of all cases

o Ad-hoc sample surveys ~ Official mortality statistics

o Cancer registry in one or more areas ~ Hospital based information system

o Other source

B. Aspects of cancer control policy (CCP)

;a Focal

point for coordination of cancer control activities

Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1970 ~ If yes to above, they also follow WHO guidelines

o Low priority given o Cultural, societal or to cancer by MoH religious factors

o Cancer not major health problem ~ Shortage of qualified personnel ~ Other barrier

Ii"

Shortage of funds

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

~ Geographical

o National or regional sample surveys performed or

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

Lack of equipment

~ A national Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A ; currently no activity; B ; Limited interventions (even if under development or if experimental) C ; established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A A

Smoking and/or tobacco chewing C C C

Alcohol and/or drug abuse C C C

Sexual education B B B

Sunlight Occupational exposure hazards A

B B C

A A

~ A national strategic programme for tobacco control exists since 1990

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 90% coverage (children < 1yr. of age), as

estimated in

-- 90 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

Screening for breast cancer routinely offered to women

[J If yes to above, mammography is part of the screening procedures ~ Screening for cervical cancer routinely offered to women

[J If yes to above, cytology is part of the screening procedures C-J Early detection programmes for oral cancer

[J Early detection programmes for skin cancer exist

Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

The percentage of all cancers diagnosed through screening Or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 70%

E. Treatment

ii2i There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

b2l WHO

list of essential drugs for cancer chemotherapy has been formally adopted

~ There are well established cancer treatment guidelines

~ External radiotherapy equipment is available

'i2! Internal radiation therapy is a'/aiiable b2l There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care [J Patients and their families generally know that cancer symptoms can be alleViated

:i'I Families are taught simple methods of home care to alleviate symptoms of cancer pain ~

Terminal 'patients receive palliative care at home

[J A curriculum for training in palliative care has been developed if] Primary health care workers receive training in palliative care ~ Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

== Complex prescription procedures [] Complex reporting to national narcotics board

!'II": Unavailability of drug i~

Misconception about its side effects (dependency)

LJ Other barrier

:'I"J Morphine is available at the Primary Heaith Care level The percentage of terminal cancer patients receiving morphine is 90% The total per capita consumption of morphine is 30 g

[J There is a national society for palliative care

-- 91 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Nauru

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.02 1994 1994 1992 1992 1992 1989 1985 Caulles Qf deatb 1994 first Heart

Population 10,600 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

100.00 41.80 2.80 5.00 54.50 8,070

Cardiovascular

second Pneumonia third fifth Neoplasms Diabetes

fourth Neonatal

-- 92 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of A. Cancer burden Sources of cancer data

o C

Nationwide registration of all cases Cancer registry in one or more areas

o Ad-hoc sample surveys [J Official mortality statistics

o Hospital based information system B. Aspects of cancer control policy (CCP) [J Focal point for coordination of cancer control activities

D Other source

Barriers to establishment of CCP

o Policies have been adopted for a multisectoral effort to manage cancer control activities

[J Low priority given to cancer by MoH

o D

Cultural, societal or religious factors Shortage of funds

D If yes to above, they also follow WHO guidelines

Cancer not major health problem Shortage of qualified personnel

[J National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

i:J

o Geographical

[J National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

D Other barrier

configuration of country

LI A national

Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A B C

= currently no activity;

For children and adolescents For the general population For specific target groups Other primary prevention activity

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment!smoking has been passed Routine vaccination of infants against Hepatitis-B

n D

-- 93 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANAlYSIS

D. Early detection

Screening for breast cancer routinely offered to women

If yes to above, mammography is part of the screening procedures

[J Screening for cervical cancer routinely offered to women

D If yes to above, cytology is part of the screening D Early detection programmes for oral cancer Early detection programmes for skin cancer exist

procedures

C: C

Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment L

There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

D Chemotherapy drugs for cancer treatment generally available ~ WHO list of essential drugs for cancer chemotherapy has been formally adopted

D There

are well established cancer treatment guidelines radiotherapy equipment is available

LJ External

[-1 Internal radiation therapy is available

D There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known F. Palliative care

D D

Patients and their families generally know that cancer symptoms can be alleviated Families are taught simple methods of home care to alleviate symptoms of cancer pain in palliative care has been developed

=.1 Terminal patients receive palliative care at home D A curriculum for training C' Primary health care workers receive training in palliative care ,::J Hospitals have adopted WHO guidelines for palliative care ::J Legislation has been passed to make morphine available for the treatment of cancer pain.

Barriers include:

o Complex prescription procedures D D Complex reporting to national narcotics board ::::: Other barrier Morphine is available at the Primary Health Care level

~ Unavailability of drug

Misconception about its side effects (dependency)

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 94 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

New Caledonia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

19.10 1995 1995 1995 1995 1995 1995 1995 1991

Population 184,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

63.00 31.00 5.00 4.90 74.02 91 6,000

til u&!:& gf d!:Dlb 1992 first Neoplasms second Circulatory system third Injuries and or Accidents fourth Respiratory system fifth Infectious and parasitic

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most frequent cancers (blank table means no data aVililable) Men first second third fourth

Women

fifth

-- 95 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 25/11/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP) [~ Focal point for coordination of cancer control activities

[] Ad-hoc sample surveys

[J Official

mortality statistics

[] Other source

Barriers to establishment of CCP

~ PoliCies have been adopted for a multisectoral effort to manage cancer control activities since 1994 ~ If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or

Low priority given to cancer by MoH health problem

Cultural, societal or religious factors

o Cancer not major

U Shortage of funds

o Shortage of qualified personnel ~ other barrier

o Geographical

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles A national Cancer Society or similar agency exists

Population density does not justify an infrastructure at the national level

[.{J Systematic evaluation of the progress made in cancer control

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A A A

Smoking and/or tobacco chewing A

Alcohol and/or drug abuse A

Sexual education A

Sunlight Occupational exposure hazards

B A

A A

A C

A national strategiC programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed

~ There is routine vaccination of infants against Hepatitis-B with 92% coverage (children

< 1yr. of age), as

estimated in 1996

-- 96 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Country/Area

New Caledonia

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

19.10 1995 1995 1995 1995 1995 1995 1995 1991

63.00 31.00 5.00 4.90 74.02 91 6,000

tlllili!:!i gf dCI!;b 1992 first Neoplasms second Circulatory system third Injuries and or Accidents fourth Respiratory system fifth Infectious and parasitic

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most frequent cancers (blInk tlble means no data aVlilable) Men first second third fourth fifth Women

-- 95 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION; ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 25/11/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases C Cancer registry in one or more areas

o Ad-hoc sample surveys ~ Official mortality statistics

o Hospital based information system B. Aspects of cancer control policy (CCP) L Focal point for coordination of cancer control activities

o Other source Barriers to establishment of CCP

POlicies have been adopted for a multisectoral effort to manage cancer control activities since 1994

Low priority given to cancer by MoH Cancer not major health problem qualified personnel

o Cultural, societal or religious factors

r- If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAPl on various life-styles L~ A national Cancer Society or similar agency exists

r::::

Shortage of funds

o Shortage of till

o Geographical configuration of country

Other barrier Population density does not justify an infrastructure at the national level

iii Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups A A A Smoking and/or tobacco chewing A B A Alcohol and/or drug abuse A B A

Sexual education A A C

Sunlight Occupational exposure hazards A A A A A C

Other primary prevention activity

o o

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed

~ There is routine vaccination of infants against Hepatitis-B with 92% coverage (children < 1yr. of age), as estimated in 1996

-- 96 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION. ESSENTIAL FEATURES AND DATA ANAlYSIS

D. Early detection

o Screening for breast cancer routinely offered to women [J If yes to above, mammography is part of the screening procedures ~

Screening for cervical cancer routinely offered to women since 1994 with 100% coverage of target population

~ If yes to above, cytology is part of the screening procedures

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted

o External radiotherapy equipment is available [] Internal radiation therapy is available

o There are well established cancer treatment guidelines

~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated C Families are taught simple methods of home care to alleviate symptoms of cancer pain ~ Terminal patients receive palliative care at home

~ A curriculum for training in palliative care has been developed

o Primary health care workers receive training in palliative care [J Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures o Complex reporting to national narcotics board o Other barrier

n Misconception about its side effects (dependency)

~ Unavailability of drug

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 97 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

New Zealand

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

270.50 1996 1995 1995 1995 1995 1995 1992 1994 ~i!Yliill !If dea!;b

Population 3,569,900 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

76.20 23.00 11.50 7.80 76.40 97 16,044

1993

first Neoplasms second Heart / Cardiovascular third Cerebrovascular fourth Respiratory system fifth Pneumonia

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most freguent cancers (blank table means no data available) Men first second third fourth fifth Colon/Rectum Lung Prostate Melanoma Bladder Women Breast Colon/Rectum Melanoma Lung Cervix

-- 98 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAl FEATURES AND DATA ANALVSIS

Questionnaire data of 01/11/97 A. Cancer burden Sources of cancer data ~ Nationwide registration of all cases

D Ad-hoc sample surveys ~ Official mortality statistics

D D

Cancer registry in one or more areas Hospital based information system

D Other source

B. Aspects of cancer control policy (CCP)

D Focal point for coordination of cancer control activities ~ Policies have been adopted for a multisectoral effort to manage cancer control activities ~ If yes to above, they also follow WHO guidelines

Barriers to establishment of CCP

Low priority given to cancer by MoH health problem

D Cultural, societal or religious factors

D Cancer not major D Shortage of qualified personnel

Shortage of funds Geographical configuration of country

National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer ongoing on knowledge, attitudes and practices (KAP) on various life-styles

D National or regional sample surveys performed or IilI A national Cancer Society or similar agency exists [J Systematic evaluation of the progress made in cancer control

D Other barrier

C. Primary prevention Current level of primary prevention activity A B C

= Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing C C C Alcohol and/or drug abuse C C C Sexual education C C C Sunlight Occupational exposure hazards C C C A A C

= currently no activity;

For children and adolescents For the general population For specific target groups Other primary prevention activity

C C C

IilI IilI

A national strategic programme for tobacco control exists since 1990

~ Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaccination of infants against Hepatitis-B with 70% coverage (children < 1yr. of age), as estimated in 1996

-- 99 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1997 with 70% coverage of target population ~ If yes to above, mammography is part of the screening procedures ~ Screening for cervical cancer routinely offered to women since 1990 with 84% coverage of target population

~ If yes to above, cytology is part of the screening procedures

C lJ

Early detection programmes for oral cancer

'::::: Early detection programmes for skin cancer exist Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 6

o WHO list of essential drugs for cancer chemotherapy has been formally adopted [.l There are well established cancer treatment guidelines ~ External radiotherapy equipment is available in the number of 29 radiotherapy machine(s)

blI Chemotherapy drugs for cancer treatment generally available

<Ii Internal radiation therapy is available ~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Pa.'iiative care Iili Patients and their families generally know that cancer symptoms can be alleviated ~

Families are taught simple methods of home care to alleviate symptoms of cancer pain patients receive palliative care at home; the percentage of terminal patients that do is 40%

[~Terminal

~ A curriculum for training in palliative care has been developed

~ Primary health care workers receive training in palliative care; the percentage trained is 50%

'J Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures n Complex reporting to national narcotics board

o Misconception about its side effects (dependency)

Unavailability of drug

o Other barrier

~ Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known ~ There is a national society for palliative care

-- 100 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANAlYSIS

Country/Area

Niue

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.26 1994 1991 1991 1991 1994 1994 1991 1990 ~ilYIi~1i 2f 5!~iI!;b

Population 2,300 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

30.50 36.70 7.20 3.00 66.00 99 3,100

1995

first Circulatory system second Respiratory system third Neoplasms fourth Septicemia fifth Senility

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rilnking 2f five most frequent Ci!nCerli (blank table meanli no dil!;iI available) Men first second third fourth fifth Women

-- 101 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 06/08/97 A. Cancer burden Sources of cancer data ~ Nationwide registration of all cases

D Ad-hoc sample surveys ~ Official mortality statistics

[J Cancer registry in one or more areas ~ Hospital based information system

D Other source

B. Aspects of cancer control policy (CCP) [J Focal point for coordination of cancer control activities Barriers to establishment of CCP

r.lI

Policies have been adopted for a multisectoral effort to manage cancer control activities since 1983 ~

Low priority given to cancer by MoH health problem

[J Cultural, societal or religious factors ~ Shortage of funds

o Cancer not major If yes to above, they also follow WHO guidelines

bi'I

Shortage of qualified personnel

[J Geographical configuration of country

~ Other barrier

[=' A national Cancer Society or similar agency exists -_; Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A B C

= currently no activity; = Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing C C C Alcohol and/or drug abuse C C C Sexual education C C C Sunlight Occupational exposure hazards B A A B B B

For children and adolescents For the general population For specific target groups Other primary prevention activity

C C C

~ A national strategic programme for tobacco control exists since 1990

Legislation regulating tobacco sales/advertisment/smoking has been passed

~ There is routine vaccination of infants against Hepatitis-B with 100% coverage (children

< 1yr. of age),

as estimated in 1996

-- 102 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND DATA ANAlYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1983, coverage unknown

LJ ~

If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women since 1983 with 80% coverage of target population

~ If yes to above, cytology is part of the screening procedures

E. Treatment

u There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o WHO list of essential drugs for cancer chemotherapy has been formally adopted o External radiotherapy equipment is available o Internal radiation therapy is available F. Palliative care

~ Chemotherapy drugs for cancer treatment generally available

o There are well established cancer treatment guidelines

~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is not known

!i'I Patients and

their families generally know that cancer symptoms can be alleviated

~ Families are taught simple methods of home care to alleviate symptoms of cancer pain

;iiij Terminal patients receive palliative care at home; the percentage of terminal patients that do is 100%

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures 0 Unavailability of drug

o !i'I

Complex reporting to national narcotics board Other barrier

Misconception about its side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 100% The total per capita consumption of morphine is not known

There is a national society for palliative care

-- 103 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL YSIS

Country/Area

Palau, Republic of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.49 1995 1995 1995 1995 1995 1990 1993 1992 ~aYilii!:::i! Qf dea!;b

Population 17,200 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

69.00 27.70 7.00 6.30 78 5,000

1995

first Circulatory system second Injuries and or Accidents third Neoplasms fourth Respiratory system fifth Perinatal

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Qf fin mQ:i!t fr!::ayen!; canc!::r:i! (blank !;abl!:: means nQ da!;a availabl!::) Men first second third fourth fifth Women

-- 104 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 01/11/97 A. Cancer burden Sources of cancer data

il2I

Nationwide registration of all cases

-=- Ad-hoc sample surveys ~ Official mortality statistics

o Cancer registry in one or more areas ~ Hospital based information system

o Other source

B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP ~ Low priority given ~ Cultural, societal or

o PoliCies have been adopted for a multisectoral effort to manage cancer control activities

to cancer by MoH ~J Cancer not major

religious factors ~ Shortage of funds

If yes to above, they also follow WHO guidelines

health problem

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

i'I CJ

Shortage of qualified personnel Other barrier

o National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

Geographical configuration of country

o A national Cancer Society or similar agency exists o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; 8 = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing C C

Alcohol and/or drug abuse C C

Sexual education C C C

Sunlight Occupational hazards exposure A A A

A B

A A

~ A national strategic programme for tobacco control exists since 1996

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 99% coverage (children < 1yr. of age), as estimated in 1997

--105--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1980, coverage unknown

If yes to above, mammography is part of the screening procedures

~ Screening for cervical cancer routinely offered to women since 1980 with 60% coverage of target population

~ If yes to above, cytology is part of the screening procedures

D C

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 58%

E. Treatment

D There are comprehensive cancer centres specialized in diagnosis and D Chemotherapy drugs for cancer treatment generally available

treatment of cancer

LJ WHO list of essential drugs for cancer chemotherapy has been

formally adopted

o External radiotherapy equipment is available D Internal radiation therapy is available

D There are well

established cancer treatment guidelines

~ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is 80%

F. Palliative care ~ Patients and their families generally know that cancer symptoms can be alleViated

i'l Families are taught simple

methods of home care to alleviate symptoms of cancer pain

~ Terminal 'patients receive palliative care at home; the percentage of terminal patients that do is 50%

C A curriculum for training

in palliative care has been developed

:~ Primary health care workers receive training in palliative care Hospitals have adopted WHO guidelines for palliative care

LJ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures ~ Complex reporting to national narcotics board

Unavailability of drug Misconception about its side effects (dependency)

~ Other barrier ~ Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 80% The total per capita consumption of morphine is 8 g

o There is a national society for palliative care

-- 106 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL VSIS

Country/Area

Papua New Guinea

Data from Country Health Information PrOfiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

462.20 1995 1995 1995 1995 1990 1995 1995 1994 ~i! !.I1!l!1 gt 5!!l!ill;b

Population 4,226,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

15.40 41.80 2.40 10.60 56.00 45 1,160

1994

first Pneumonia second Perinatal third Malaria fourth Meningitis fifth Tuberculosis

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five most fr!l!guent canC!l!r5 (blilnk tabl!l! means ng 5!atil aVililable) Men first second third fourth fifth Oral cavity Liver Non-Hodgkin lymphoma Colon/Rectum Leukaemia Women Cervix Oral cavity Breast Liver Uterus

-- 107 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND DATA ANALYSIS

Questionnaire data of A. Cancer burden

o Nationwide registration of all cases o Cancer registry in one or more areas ::::J Hospital based information system

Sources of cancer data

o Ad-hoc sample surveys o Official mortality statistics o other source

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP [] Low priority given to cancer by MoH

o Cultural, societal or

If yes to above, they also follow WHO guidelines

o Cancer not major health problem

religious factors

Shortage of funds

'I National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

Shortage of qualified personnel other barrier

[J Geographical configuration of country

o National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

::::J A national Cancer Society or similar agency exists [l Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Smoking and/or tobacco chewing Alcohol and/or drug abuse

Sexual education

Sunlight Occupational exposure hazards

Other primary prevention activity

A national strategic programme for tobacco control exists

[J Legislation regulating tobacco sales/advertisment/smoking has been passed [J Routine vaccination of infants against Hepatitis-B

-- 108 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAL FEATURES AND DATA ANAlYSIS

D. Early detection

Screening for breast cancer routinely offered to women

D C

If yes to above, mammography is part of the screening procedures

o Screening for cervical cancer routinely offered to women If yes to above, cytology is part of the screening procedures

Early detection programmes for oral cancer

o Early detection programmes for skin cancer exist

o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer o There are well established cancer treatment guidelines o WHO list of essential drugs for cancer chemotherapy has been formally adopted D Chemotherapy drugs for cancer treatment generally available

o External radiotherapy equipment is available

[J Internal radiation therapy is available [J There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated o Families are taught simple methods of home care to alleviate symptoms of cancer pain DTerminal' patients receive palliative care at home

o A curriculum for training in palliative care has been developed I.] Primary health care workers receive training in palliative care [J Hospitals have adopted WHO guidelines for palliative care [] Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures '0 Complex reporting to national narcotics board

o Misconception about its Side effects (dependency)

Unavailability of dnug

[J Other barrier

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 109--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Philippines

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

300.00 1996 1990 1995 1995 1996 1996 1990 1995 !;;ilY:!~s Qf d~atb

Population 69,946,200 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

48.70 37.40 3.90 6.10 68.50 94 950

1993

first Heart / Cardiovascular second Circulatory system third Pneumonia fourth Neoplasms fifth Tuberculosis

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Qf five mQst fregyent Cilncer:! (blilnk tilble meiln:! nQ data ilvililable) Men first second third fourth fifth Lung Liver Colon/Rectum Prostate Stomach Women Breast Cervix Lung Colon/Rectum Ovary

-- 110 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

Questionnaire data of 29/10/97 A. Cancer burden Sources of cancer data

Nationwide registration of all cases

Ad-hoc sample surveys

~ Cancer registry in one or more areas

~ Official mortality statistics

Ii2i Hospital

based information system

D Other source

B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

Barriers to establishment of CCP ~ Low priority given ~ Cultural, societal or

~ Policies have been adopted for a multisectoral effort to manage cancer control activities ~ If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or

to cancer by MoH

religious factors ~ Shortage of funds ~ Geographical

Cancer not major health problem

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

~ Shortage of qualified personnel

other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer Society or similar agency exists

D Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C =. estab'lished regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A C A

Smoking and/or tobacco chewing C C A

Alcohol and/or drug abuse A A A

Sexual education A C C

Sunlight Occupational exposure hazards C C C A A B

estimated in

--111--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTiAl FEATURES AND DATA ANAlYSIS

D. Early detection

Screening for breast cancer routinely offered to women since 1990 with 40% coverage of target population

o If yes to above, mammography is part of the screening procedures ~ Screening for cervical cancer routinely offered to women since 1990 with 10% coverage of target population

~ If yes to above, cytology is part of the screening procedures

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 7 ~ Chemotherapy drugs for cancer treatment generally available ~ WHO list of essential drugs for cancer chemotherapy has been formally adopted ~ There are well established cancer treatment guidelines

~ External radiotherapy equipment is available

o There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 65%

~ Internal radiation therapy is available

F. Palliative care ~ Patients and their families generally know that cancer symptoms can be alleViated ~

Families are taught Simple methods of home care to alleviate symptoms of cancer pain patients receive palliative care at home; the percentage of terminal patients that do is 30%

~ Terminal

~ A curriculum for training in palliative care has been developed

~ Primary health care workers receive training in palliative care; the percentage trained is 30% ~ Hospitals have adopted WHO guidelines for palliative care; the percentage of hospitals that have is 60% ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Banriers include:

o Complex prescription procedures

~ Unavailability of drug

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is 70% The total per capita consumption of morphine is 25 Total Kg ~ There is a national society for palliative care

o Complex reporting to national narcotiCS board o Other barrier

o Misconception about its side effects (dependency)

-- 112 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION. ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Pitcairn Island

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km) Population Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

Causes of death first second third fourth fifth

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rankinq of five most frequent cancers (blank table means no data ayailable) Men first second third fourth fifth Women

--113--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTiAl FEATURES AND DATA ANALYSIS

Questionnaire data of A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas

o Ad-hoc sample surveys o Official mortality statistics

o Hospital based information system B. Aspects of cancer control policy (CCP)

o Other source Barriers to establishment of CCP

o Focal point for coordination of cancer control activities

o Policies have been adopted for a multisectoral effort to manage cancer control activities

o Low priority given o Cultural, societal or to cancer by MoH health problem religious factors

o If yes to above, they also follow WHO guidelines

o Cancer not major

o National or regional sample surveys performed or o National or regional sample surveys performed or

o Shortage of

ongoing on exposure to known risk factors for cancer

qualified personnel

o Shortage of funds o Geographical configuration of country

o other barrier

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o A national Cancer Society or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A B C

= currently no activity;

For children and adolescents For the general population For specific target groups

Other primary prevention activity

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

o o

-- 114--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND OATAANAlYSIS

D. Early detection

o Screening for breast cancer routinely offered to women ' \ If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women

o If yes to above, cytology is part of the screening procedures

E. Treatment

o There are well established cancer treatment guidelines o External radiotherapy equipment is available [J Internal radiation therapy is available [J There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated o Families are taught simple methods of home care to alleviate symptoms of cancer pain OTerminal'patients receive palliative care at home

o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain, Barriers include: o Complex reporting to national narcotics board [J other barrier

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Complex prescription procedures 0

Unavailability of drug Misconception about its side effects (dependency)

r:::J Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national SOCiety for palliative care

-- 115 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Samoa

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

2.90 1995 1995 1995 1995 1994 1992 1981 1992 ~aus~s

Population 177,900 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

21.00 46.20 3.50 7.20 64.00 98 646

Qf d~ath 1994 first Injuries and or Accidents second Heart / Cardiovascular third Cerebrovascular fourth Neoplasms fifth Pneumonia

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Qf five most frequent cancers (blank table means no data available) Men first second third fourth fifth Stomach Prostate Leukaemia Non-Hodgkin lymphoma Lung Women Breast Cervix Colon/Rectum Uterus Leukaemia

--116--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 20/08/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas Ii'! Hospital based information system B. Aspects of cancer control policy (CCP)

o Ad-hoc sample surveys Ii'! Official mortality statistics ~ Other source

Histology diagnosis

o Focal point for coordination of cancer control activities ~ Policies have been adopted for a multi sectoral effort to manage cancer control activities since 1997

Barriers to establishment of CCP

o Low priority given o Cultural, societal or to cancer by MoH health problem religious factors

Ii'!

Ii'! Cancer not major If yes to above, they also follow WHO guidelines

Ii'! Shortage of funds

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

Ii'! Shortage of qualified personnel ~ Other barrier

o Geographical configuration of country

Ii'! National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

Inadequate resources, manpower and funds.

Ii'! A national Cancer Society or similar agency exists [J Systematic evaluation of the progress made in cancer control

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity A

Smoking and/or tobacco chewing C C A

Alcohol and/or drug abuse A A A

Sexual education A A

Sunlight Occupational exposure hazards A A A A A A

C A

~ A national strategic programme for tobacco control exists since 1995

C Ii'!

Legislation regulating tobacco sales/advertisment/smoking has been passed

There is routine vaccination of infants against Hepatitis-B with 95% coverage (children < 1yr. of age), as estimated in

-- 117--

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures ~ Screening for cervical cancer routinely offered to women since 1990, coverage unknown

~ If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o C Early detection programmes for skin cancer exist Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 90%

E. Treatment ~ There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 2 ~ Chemotherapy drugs for cancer treatment generally available ~ WHO list of essential drugs for cancer chemotherapy has been formally adopted

o External radiotherapy equipment is available o Internal radiation therapy is available

o There are well established cancer treatment guidelines LJ There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleViated ~ Families are taught simple methods of home care to alleviate symptoms of cancer pain ~ Terminal

patients receive palliative care at home; the percentage of terminal patients that do is 1%

[J A curriculum for training in palliative care has been developed

o Primary health care workers receive training in palliative care have adopted WHO guidelines for palliative care

U Hospitals

o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures L.J Complex reporting to national narcotics board o Other barrier

~ Unavailability of drug

Misconception about its side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 10% The total per capita consumption of morphine is not known

D There is a national society for palliative care

-- 118 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Singapore

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.65 1995 1995 1995 1995 1995 1995 1995 1995 ~iY:t~:t Qf d~itb

Population 2,986,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage

100.00 22.90 6.80 4.80 76.40 92

1995

first Neoplasms second Heart / Cardiovascular third Pneumonia fourth Cerebrovascular fifth Injuries and or Accidents

GNP per capita, $US 24,718

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Qf five most frequent cancers (blank table means nQ data aVillable) Men first second third fourth fifth Lung Colon/Rectum Stomach Uver Nasopharynx Women Breast Colon/Rectum Lung Cervix Stomach

-- 119 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 25/09/98 A. Cancer burden Sources of cancer data ~ Nationwide registration of all cases

Ad-hoc sample surveys

~ Cancer registry in one or more areas, with coverage of 100% ~ Hospital based information system

~ Official mortality statistics

D Other source

B. Aspects of cancer control policy (CCP) ~ Focal pOint for coordination of cancer control activities Barriers to establishment of CCP

~ Policies have been adopted for a multisectoral effort to manage cancer control activities since 1985 ~ If yes to above, they also follow WHO guidelines ~ National or regional sample surveys performed or

o Low priority given o Cultural, SOCietal or to cancer by MoH religiouS factors

D D D

Cancer not major health problem Shortage of qualified personnel Other barrier

o Shortage of funds D Geographical configuration of country

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

ongoing on knowledge, attitudes and practices (KAP) on various life-styles ~ A national Cancer SOCiety or similar agency exists

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A = currently no activity; B = Limited inteNentions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing C C A

Alcohol and/or drug abuse C C C

Sexual education C B A

Sunlight Occupational exposure hazards A A A A B

C C A

~ A national strategiC programme for tobacco control exists Since 1986

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 94% coverage (children < 1yr. of age), as

estimated in 1997

-- 120 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATAANALVSIS

D. Early detection

r::J

Screening for breast cancer routinely offered to women

D D D

If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women If yes to above, cytology is part of the screening procedures

D D Il2I

The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

Il2I There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the Il2I Chemotherapy drugs for cancer treatment generally available D WHO list of essential drugs for cancer chemotherapy has been formally adopted Il2I There are well established cancer treatment guidelines Il2I External radiotherapy equipment is available in the number of 10 radiotherapy machine(s) Il2I Internal radiation therapy is available Il2I There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 95%

number of 1

F. Palliative care U Patients and their families generally know that cancer symptoms can be alleviated

Il2I Families are taught simple [J A curriculum

methods of home care to alleviate symptoms of cancer pain

~ Terminal patients receive palliative care at home; the percentage of terminal patients that do is 50%

for training in palliative care has been developed

[J Primary health care workers receive training in palliative care

D Hospitals have adopted WHO guidelines for palliative care Il2I Legislation has been passed to make morphine available for the treatment of cancer pain. Banriers include: :::J Complex prescription procedures :c Unavailability of drug C Complex reporting to national narcotics board ~ Misconception about its side effects (dependency) I] other barrier

Il2I

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known ~ There is a national society for palliative care

-- 121 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Solomon Islands

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area lin 1000 sq. km)

28.40 1995 1994 1995 1995 1994 1994 1992 1994 Ci!YSll:!i Qf !;Is::ath 1995 first Respiratory system second Diarrhoea third Malaria fourth fifth

Population 393,800 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

13.00 45.00 4.00 4.00 71.00 22 810

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking Qf five mQH frs::gus::nt Ci!ncs::rs (bli!nk tabls:: mS::i!ns no !;lata availi!blel Men first second third fourth fifth Oral cavity Liver Non-Hodgkin lymphoma Colon/Rectum Lung Women Cervix Breast Oral cavity Liver Ovary

-- 122 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAl FEATURES AND DATAAHALYSIS

Questionnaire data of 21/07/97 A. Cancer burden Sources of cancer data

LJ Nationwide registration of all cases [J Cancer registry in one or more areas ~

o Ad-hoc sample surveys o Official mortality statistics o Other source

Hospital based information system

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities o Policies have been adopted for a multisectoral effort to manage cancer control activities

Barriers to establishment of CCP

o Low priority given to cancer by MoH ~ Cancer not major

~ Cultural, societal or

religious factors ~ Shortage of funds ~ Geographical

o If yes to above, they also follow WHO guidelines

health problem ~ Shortage of

o National or regional sample surveys performed or o National or regional sample surveys performed or

ongoing on exposure to known risk factors for cancer

qualified personnel

o Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o A national Cancer Society or similar agency exists o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity

A B C

= currently no activity; = Limite!i interventions (even if under development or if experimental) = established regional or nation-wide programmes • Diet and exercise Smoking and/or tobacco chewing B B Alcohol and/or drug abuse B Sexual education Sunlight Occupational exposure hazards A A A A A

For children and adolescents For the general population For specific target groups Other primary prevention activity

B B A

B A

~ A national strategic programme for tobacco control exists Since

~ Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with 76% coverage (children < lyr. of age), as

estimated in

-- 123 -I

CANCER DATABASE FOR THE WESTERN PACIFIC REGION, ESSENTIAl FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures o Screening for cervical cancer routinely offered to women

o If yes to above, cytology Is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist [j Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer ~ Chemotherapy drugs for cancer treatment generally available

o External radiotherapy equipment is available o Internal radiation therapy is available o F. Palliative care

o There are well established cancer treatment guidelines

o WHO list of essential drugs for cancer chemotherapy has been formally adopted

There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

o Patients and their families generally know that cancer symptoms can be alleViated ~ Families are taught simple methods of home care to alleviate symptoms of cancer pain

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures 0 Unavailability of drug o Complex reporting to national narcotics board o Other barrier [] Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

OTerminai patients receive palliative care at'home

o Hospitals have adopted WHO guidelines for palliative care

o Misconception about its side effects (dependency)

o There is a national society for palliative care

. -- 124--

CANCER DATABASE FOR THE V'lESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Tokelau

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.01 1995 1995 1995 1995 1991 1994 1993 1993 !,;;II YISlI

Population 1,600 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, $US

41.00 43.00 7.40 8.20 100 3,550

gf II!:!!!;!:! 1990 first Circulatory system second Respiratory system third Neoplasms fourth Congenital abnomalies fifth

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five mgst freguSlnt cancers (blank table m!:ans no data availablSl) Men first second third fourth fifth Women

-- 125 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 21/07/97 A. Cancer burden

o Nationwide registration of all cases o Cancer registry in one or more areas ~ Hospital based information system

Sources of cancer data

o Ad-hoc sample surveys o Official mortality statistics

o Other source Barriers to establishment of CCP

B. Aspects of cancer control policy (CCP)

o Focal point for coordination of cancer control activities

o Policies have been adopted for a multisectoral effort' to manage cancer control activities

o Low priority given o Cultural, societal or to cancer by MoH health problem religious factors ~ Shortage of funds

o If yes to above, they also follow WHO guidelines o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

n Cancer not major ~ Shortage of

qualified personnel

o Geographical

National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles made in cancer control

o Other barrier

configuration of country

i1 A national Cancer Society or similar agency exists

::J Systematic evaluation of the progress C. Primary prevention

(.1

Current level of primary prevention activity A = currently no activity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes

Diet and exercise For children and adolescents For the general population For specific target grouj:'s other primary prevention activity B B B

Smoking and/or tobacco chewing

Alcohol and/or drug abuse

Sexual education C C

Sunlight Occupational exposure hazards B B

C C B

B B

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed estimated in

~ There is routine vaccination of infants against Hepatitis-B with 65% coverage (children < lyr. of age), as

-- 126 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

D. Early detection ~ Screening for breast cancer routinely offered to women since 1996, coverage unknown

L ~

If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women

=:J [J

If yes to above, cytol09Y is part of the screening procedures

o Early detection programmes for oral cancer Early detection programmes for skin cancer exist for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 95% ~ Primary health care workers are trained in the value of early detection and are in a position to refer patients

E. Treatment

o Chemotherapy drugs for cancer treatment generally available

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer

o WHO list of essential drugs for cancer chemotherapy has been formally adopted

o External radiotherapy equipment is available o Internal radiation therapy is available

~ There are well established cancer treatment guidelines

~ There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care lY'! Patients and their families generally know that cancer symptoms can be alleviated ~ Families are taught simple methods of home care to alleviate symptoms of cancer pain

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care o Complex prescription procedures [] Complex reporting to national narcotics board

Ii'! Terminal

patients receive palliative care at home

o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Other barrier 0 0 Unavailability of drug Misconception about its side effects (dependency) ~ Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is 0% The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 127 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL YSIS

Country/Area

Tonga

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.75 1995 1995 1995 1995 1995 1995 1992 1994 ~ilYlel gf d!!ilth

Population 98,500 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

36.00 40.20 4.20 4.10 68.00 96 1,590

1995

first Heart

Cardiovascular

second Senility third Cerebrovascular fourth fifth

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking gf fiv!! malt frequent canc!!rs (blank table m!!ilnl no data ilvailablel Men first second third fourth fifth Women

. -- 128 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTiAl FEATURES AND DATA ANAlYSIS

Questionnaire data of A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP)

o Ad-hoc sample surveys o Official mortality statistics C Other source

Focal point for coordination of cancer control activities manage cancer control activities

Barriers to establishment of CCP

o Policies have been adopted for a multisectoral effort to iJ If yes to above, they also follow WHO guidelines

Low priority given

to cancer by MoH health problem

o Cultural, societal or religious factors

o Cancer not major

Shortage of funds

o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

u Shortage of

qualified personnel

o Geographical configuration of country

o National or regional sample surveys performed or ongOing on knowledge, attitudes and practices (KAP) on various life-styles

o Other barrier

Diet and exercise For Children and adolescents For the general population For specific target groups Other primary prevention activity l_~

Smoking and/or tobacco chewing

Alcohol and/or drug abuse

Sexual education

Sunlight Occupational exposure hazards

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed Routine vaccination of infants against Hepatitis-B

LJ rJ

-- 129 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures o Screening for cervical cancer routinely offered to women o If yes to above, cytology is part of the screening procedures Early detection programmes for skin cancer exist for diagnosis

o Early detection programmes for oral cancer n

o Primary health care workers are trained in the value of early detection and are in a position to refer patients The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer LJ Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines C External radiotherapy equipment is available

o Internal radiation therapy is available o There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated ~ Families are taught Simple methods of home care to alleviate symptoms of cancer pain

o Terminal patients receive palliative care at home o A curriculum for training in palliative care has been developed C Primary health care workers receive training in palliative care

o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: o Complex prescription procedures 0 Unavailability of drug o Complex reporting to national narcotiCS board o Other barrier 0 Misconception about its side effects (dependency) [] Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 130 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

Country/Area

Tuvalu

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.03 1994 1991 1994 1994 1994 1991 1991 1994 !:;ays!l!li! Qf !lej!th 1994 first Heart I Cardiovascular second Cerebrovascular third Tuberculosis fourth Infant fifth Senility

Population 9,400 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

42.50 33.50 5.70 8.20 65.60 100 1,640

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rj!nking of five m0li!t frequ!l!nt cancers (blank tj!ble m!l!ans no !lata j!vj!ilj!blel Men first second third fourth fifth Women

-- 131 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Questionnaire data of 24/10/97 A. Cancer burden Sources of cancer data

o Nationwide registration of all cases o Cancer registry in one or more areas o Hospital based information system B. Aspects of cancer control policy (CCP) ~ Focal point for coordination of cancer control activities

o Ad-hoc sample surveys ~ Official mortality statistics

o Other source

Barriers to establishment of CCP ~ Low priority given

o Policies have been adopted for a multisectoral effort to manage cancer control activities

~ Cultural, SOCietal or

to cancer by MoH ~ Cancer not major

religious factors ~ Shortage of funds ~ Geographical

o If yes to above, they also follow WHO guidelines o National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

health problem ~ Shortage of

qualified personnel

o National or regional sample surveys performed or

o Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Systematic evaluation of the progress made in cancer control C. Primary prevention Current level of primary prevention activity A B C

o A national Cancer SOCiety or similar agency exists

= currently no activity; = Limited interventions (even if under development or if experimental) = established regional or nation-wide programmes Diet and exercise Smoking and/or tobacco chewing B B A Alcohol and/or drug abuse C B A Sexual education C

Sunlight Occupational exposure hazards C B A A A A

For Children and adolescents For the general population For specific target groups Other primary prevention activity

B B A

B A

o o ~

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaccination of infants against Hepatitis-B with 80% coverage (children < 1yr. of age), as estimated in 1996

-- 132 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATLRES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o ~

If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women since 1994 with 50% coverage of target population

li'I

If yes to above, cytology is part of the screening procedures

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer o Chemotherapy drugs for cancer treatment generally available o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines o External radiotherapy equipment is available o Internal radiation therapy is available o There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated o Families are taught simple methods of home care to alleviate symptoms of cancer pain o Terminal patients receive palliative care at home o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include: C Complex prescription procedures Other barrier

o Complex reporting to national narcotics board

0 0

Unavailability of drug Misconception about its side effects (dependency)

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

[l There is a national society for palliative care

-- 133 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

CountrylArea

Vanuatu

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

12.20 1994 1995 1996 1996 1991 1995 1991 1994 l:;au!!~:! of deilth

Population 162,200 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate 11000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

19.30 43.10 2.30 9.00 66.00 33 1,150

1994

first Heart / Cardiovascular second Respiratory system third Neoplasms fourth Senility fifth Renal

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of five mo:!t frequent cancer:! (blank table mean!! no data available) Men first second third fourth fifth Liver Colon/Rectum Melanoma Non-Hodgkin lymphoma Thyroid Women Breast Cervix Thyroid Ovary Leukaemia

-- 134 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAL YSIS

Questionnaire data of 22/07/97 A. Cancer burden Sources of cancer data

u 521

Nationwide registration of all cases Cancer registry in one or more areas, with coverage of 75% based information system

[1 Ad-hoc sample surveys [J Official mortality statistics

li'I Hospital

[1 Other source

B. Aspects of cancer control policy (CCP) [1 Focal point for coordination of cancer control activities Barriers to establishment of CCP

[J Policies have been adopted

for a multisectoral effort to manage cancer control activities

o li'I

Low priority given to cancer by MoH Cancer not major health problem qualified personnel

li'I li'I

Cultural, societal or religious factors Shortage of funds

[:J

If yes to above, they also follow WHO guidelines

[1 National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer

~ Shortage of

~ Geographical

[l National or regional sample surveys performed or ongoing on knowledge, attitudes and practices (KAP) on various life-styles

o Other barrier

configuration of country

[1 A national Cancer Society or similar agency exists

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing A A A

Alcohol and/or drug abuse A A A

Sexual education A A A

Sunlight Occupational exposure hazards A A A A A A

A A A

[] A national strategic programme for tobacco control exists

[1 Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaccination of infants against Hepatitis-B with % coverage (children < 1yr. of age), as estimated in

-- 135 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women o If yes to above, mammography is part of the screening procedures

o Screening for cervical cancer routinely offered to women o If yes to above, cytology is part of the screening procedures o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer o Chemotherapy drugs for cancer treatment generally available

There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is not known

F. Palliative care

o Patients and their families generally know that cancer symptoms can be alleviated o Families are taught simple methods of home care to alleviate symptoms of cancer pain

DTerminal patients receive palliative care at home

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care o Hospitals have adopted WHO guidelines for palliative care C

o Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex reporting to national narcotics board o Other barrier

Complex prescription procedures

o Misconception about its side effects (dependency)

Unavailability of drug

o Morphine is available at the Primary Health Care level The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 136 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION, ESSENTIAL FEATURES AND DATAANALVSIS

Country/Area

Viet N am, Socialist Republic of

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

330.90 1995 1995 1995 1995 1995 1995 1993 1995 'auli!1!1i gf dutb 1995 first Neonatal second Chemical toxicosis third Pneumonia fourth Tuberculosis fifth Injuries and or Accidents

Population 73,959,000 Percentage living in urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexesI, y rs Literacy rate, percentage GNP per capita, $US

20.20 39.00 4.70 6.70 65.00 92 276

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Ranking of fiv!1! mOlit fr!1!guent canC!1!rli (blank tabl!1! m!1!ans no data anilabl!1!) Men first second third fourth fifth Lung Uver Stomach Colon/Rectum Nasopharynx Women Cervix Breast Stomach Lung Colon/Rectum

-- 137 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAl FEATURES AND DATA ANALYSIS

Questionnaire data of 16/01/98 A. Cancer burden Sources of cancer data [] Nationwide registration of all cases ~ Ad-hoc sample surveys

I'll

Cancer registry in one or more areas, with coverage of 7%

o Official mortality statistics o Other source

~ Hospital based information system

B. Aspects of cancer control policy (CCP) ;ill Focal pOint for coordination of cancer control activities Barriers to establishment of CCP ~ Low priority given

o Policies have been adopted for a multisectoral effort to manage cancer control activities

to cancer by MoH

Cultural, societal or religiOUS factors

C If yes to

above, they also follow WHO guidelines

o Cancer not major health problem ~ Shortage of

~ Shortage of funds

~ National or regional sample surveys performed or

o Geographical

ongoing on exposure to known risk factors for cancer ~ National or regional sample surveys performed or

qualified personnel

[J Other barrier

configuration of country

ongoing on knowledge, attitudes and practices (KAP) on various life-styles

li?j A national Cancer SOciety or similar agency eXists

[j Systematic evaluation of the progress made in cancer control

C. Primary prevention Current level of primary prevention activity A = currently no actiVity; B = Limited interventions (even if under development or if experimental) C = established regional or nation-wide programmes Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity ~ A national strategic programme for tobacco control exists Since 1990

Smoking and/or tobacco chewing A B B

Alcohol and/or drug abuse A B A

Sexual education A B B

Sunlight Occupational exposure hazards A B A A A B

A B B

[J Legislation regulating tobacco sales/advertisment/smoking has been passed ~ There is routine vaCCination of infants against Hepatitis-B with 100% coverage (children < 1yr. of age),

as estimated in 1997

-- 138 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

Ii'I ~

Screening for breast cancer routinely offered to women since 1996, coverage unknown

Ii'I Ii'I

If yes to above, mammography is part of the screening procedures

Screening for cervical cancer routinely offered to women since 1996, coverage unknown If yes to above, cytology is part of the screening procedures

o Early detection programmes for oral cancer o Early detection programmes for skin cancer exist o Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis The percentage of all cancers diagnosed through screening or early detection programmes is 0% The percentage of all cancers diagnosed at an advanced (generally not curable) stage is 70%

E. Treatment

Ii'I There are comprehensive cancer centres specialized in diagnosis and treatment of cancer in the number of 2 Ii'I Chemotherapy drugs for cancer treatment generally available ~ WHO list of essential drugs for cancer chemotherapy has been formally adopted

ii"I There are well established cancer treatment guidelines Ii'I External radiotherapy equipment is available in the number of 10 radiotherapy machine(s) Ii'I Internal radiation therapy is available

o There are well established follow-up guidelines

The percentage of patients diagnosed with curable cancer who receive treatment is 50%

F. Palliative care

o A curriculum for training in palliative care has been developed o Primary health care workers receive training in palliative care U Complex prescription procedures ~ Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Terminal patients receive palliative care at home

Ii'I Patients and their families generally know that cancer symptoms can be alleviated Ii'I Families are taught simple methods of home care to alleviate symptoms of cancer pain

o Complex reporting to national narcotics board Lj Other barrier

0 Ii'I

Unavailability of drug Misconception about its side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients receiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 139 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

Country/Area

Wallis and Futuna

Data from Country Health Information Profiles, 1997 Edition, WHO, Western Pacific Regional Office Surface area (in 1000 sq. km)

0.27 1994 1994 1994 1994 1990 1990 1990

Population 14,400 Percentage living In urban area Percentage less than 15 years of age Percentage more than 65 years of age Crude death rate /1000 Life expectancy (both sexes), yrs Literacy rate, percentage GNP per capita, SUS

0.00 41.90 4.10 6.00 68.00 1,400

!;;IYliH 2f s1llilth first second third fourth fifth

Data on cancer incidences from Globocan 1, WHO, International Agency for Research on Cancer, Lyon, 1998. Rilnking 2f five m2H freguent clncllfs (blank tablll mllans no data availablll) Men Women

first second third fourth fifth

. -- 140 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANAlYSIS

Questionnaire data of 12/08/97 A. Cancer burden Sources of cancer data

lJ D

Nationwide registration of all cases Cancer registry in one or more areas

D Ad-hoc sample surveys D Official mortality statistics

=- Hospital based information system B. Aspects of cancer control policy (CCP)

o Other source

Focal point for coordination of cancer control activities manage cancer control activities

Barriers to establishment of CCP

[= Policies have been adopted for a multisectoral effort to

Low priority given to cancer by MoH health problem

Cultural, societal or religious factors Shortage of funds

::J C

D Cancer not major If yes to above, they also follow WHO guidelines

Ill!

National or regional sample surveys performed or ongoing on exposure to known risk factors for cancer ongoing on knowledge, attitudes and practices (KAP) on various life-styles

Ill! Shortage of qualified personnel

o Geographical

D National or regional sample surveys performed or D [J A national Cancer Society or similar agency eXists Systematic evaluation of the progress made in cancer control

Ill! Other barrier

configuration of country

Absence of concern for health because health care is free

Diet and exercise For children and adolescents For the general population For specific target groups Other primary prevention activity

Smoking and/or tobacco chewing A A

Alcohol and/or drug abuse A

Sexual education A

Sunlight Occupational hazards exposure A A A A A

A A A

A A

A national strategic programme for tobacco control exists Legislation regulating tobacco sales/advertisment/smoking has been passed There is routine vaccination of infants against Hepatitis-B with 100% coverage (children < 1yr. of age), as estimated in 1997

o Ill!

-- 141 --

CANCER DATABASE FOR THE WESTERN PACIFIC REGION: ESSENTIAL FEATURES AND DATA ANALYSIS

D. Early detection

o Screening for breast cancer routinely offered to women

o If yes to above, mammography is part of the screening procedures o Screening for cervical cancer routinely offered to women [J Early detection programmes for oral cancer

o If yes to above, cytology is part of the screening procedures Primary health care workers are trained in the value of early detection and are in a position to refer patients for diagnosis

o Early detection programmes for skin cancer exist D The percentage of all cancers diagnosed through screening or early detection programmes is not known The percentage of all cancers diagnosed at an advanced (generally not curable) stage is not known

E. Treatment

o There are comprehensive cancer centres specialized in diagnosis and treatment of cancer li2I Chemotherapy drugs for cancer treatment generally available

o WHO list of essential drugs for cancer chemotherapy has been formally adopted o There are well established cancer treatment guidelines o External radiotherapy equipment is available o Internal radiation therapy is available L: There are well established follow-up guidelines The percentage of patients diagnosed with curable cancer who receive treatment is 100%

F. Palliative care [] Patients and their families generally know that cancer symptoms can be alleviated

D Families are taught simple methods of home care to alleviate symptoms of cancer pain D Terminal patients receive palliative care at home

n A curriculum for training in palliative care has been developed C Primary health care workers receive training in palliative care L Hospitals have adopted WHO guidelines for palliative care ~ Legislation has been passed to make morphine available for the treatment of cancer pain. Barriers include:

o Complex prescription procedures o Complex reporting to national narcotics board [J Other barrier

[J Unavailability of drug

Misconception about its side effects (dependency)

Morphine is available at the Primary Health Care level

The percentage of terminal cancer patients reteiving morphine is not known The total per capita consumption of morphine is not known

o There is a national society for palliative care

-- 142 --

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Publications

Дата принятия 31 декабря 1999 г.

Источник Всемирная организация здравоохранения