National cancer control plans in Southeast Asia: A systematic comparison.

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Background: Southeast Asia (SEA) is experiencing a significant increase in cancer burden with 1.15 million new cases recorded in 2022; and 1.4 million deaths projected to occur by 2050.Central to the region’s response to this burden are the National Cancer Control Plans (NCCPs), which remain poorly characterized. Therefore we performed a systematic analysis to compare NCCPs across the 11 SEA nations with each other and against UN and WHO cancer control frameworks in an effort to better inform national policy building. Methods: Data was taken from the International Cancer Control Partnership (ICCP) portal 11 and official government websites to identify the most recent NCCPs or functionally equivalent policies. The content and alignment of NCCPs were mapped against frameworks informed by the WHO Assessment Tool , and previous frameworks. Plans were mapped by structure (duration, type, governance, health workforce, financing, health information systems, and monitoring and evaluation), by service delivery scope, by stakeholders involved, by health workforce engaged, by vulnerable populations covered, and against WHO and UN global strategies of cancer care and non-communicable diseases. Results: Among the 11 SEA countries, only 6 were stand-alone plans. All were under the ministries of health, most had 5 year implementation cycles, and only 3 had comprehensive financial protection mechanisms. Only 4 had comprehensive referral systems and well-established population based national cancer registries. Preventive strategies largely targeted behavioral risk, HPV, and HBV while early detection focused heavily on cervical (91%) and breast cancer (73%). All prioritized expansion of diagnostic and treatment capacity but few addressed hematopoietic stem cell transplantation and immunotherapy. Few addressed equitable opioid access (45%). All NCCPs had provisions for palliative care but not all addressed bereavement care for caregivers (73%). Medical and surgical oncologists emerged as the most engaged, with medical physicists and patient navigators as the least engaged health workforce. Stakeholder engagement was uneven with community leaders and religious groups being the least engaged. Indigenous Peoples, LGBTQIA+, and Refugees were the least covered vulnerable groups. Alignment with WHO and UN frameworks was uneven (27-91% fully aligned). Conclusions: Our comparative analysis reveals that NCCPs in SEA demonstrate persistent gaps between policy and implementation, are largely ministry of health-centric, demonstrate uneven service delivery, inadequate workforce strategies, limited stakeholder inclusion and coverage of vulnerable populations. Strengthening these plans are critical to closing cancer care gaps and improving inequity driven cancer outcomes across the region.