Setting the policy agenda for cancer control reform: Australia's first national cancer control plan

Cancer outcomes in Australia are among the best in the world;1 however, these outcomes are not experienced equitably. There are significant disparities in cancer outcomes and experience among specific groups in Australia, including Aboriginal and Torres Strait Islander people.2 Such disparities are unacceptable and require whole-of-system, coordinated, national level effort, to ensure the future of cancer control in Australia is one where world class cancer outcomes and experiences are within reach for all Australians. In November 2020, the then Minister for Health and Aged Care asked Cancer Australia to lead the development of the Australian Cancer Plan, to provide an overarching national approach to cancer control that meets the needs of Australians now and in the future. The Plan is a future-focused 10-year national framework that will accelerate world class cancer outcomes and improve the lives of all Australians affected by cancer. The Plan is designed as a digital platform and is accessible online at www.australiancancerplan.gov.au. From inception to delivery, a comprehensive stakeholder engagement strategy underpinned the development of the Plan. The Plan was co-designed, refined and tested in consultation with a diverse range of stakeholders covering the breadth and depth of the cancer control and broader health sectors. Feedback was received via more than 700 submissions and consultations, encompassing more than 400 groups and 300 individuals. Box 1 outlines the key stakeholder engagement activities throughout the Plan's development. The Plan recognises that distinct disparities exist for Aboriginal and Torres Strait Islander people diagnosed with cancer. Aboriginal and Torres Strait Islander people are more likely to be diagnosed with cancer, have poorer survival outcomes, and die from cancer when compared with non-Indigenous Australians.5 The age-standardised mortality rate for all cancers combined for Aboriginal and Torres Strait Islander people increased by 26% between 1998 and 2015 and decreased for non-Indigenous people by 16% during the same period.6 Achieving equity for Aboriginal and Torres Strait Islander people is the most significant ambition for the future of cancer care in Australia. Components of the Plan relevant to Aboriginal and Torres Strait Islander people were developed through a co-design approach with Indigenous leaders comprising Cancer Australia's Leadership Group on Aboriginal and Torres Strait Islander Cancer Control, jurisdictional Aboriginal and Torres Strait Islander health policy representatives, and other representatives. The co-design approach to the development of the Plan aligned with best practice co-design principles.7 As such, Aboriginal and Torres Strait Islander representatives actively participated in key engagement activities, contributed to drafting and refining the 10-year ambition statements and the 2- and 5-year goals and actions, and reviewed draft Plan content. The Plan identifies six strategic objectives that require national, coordinated leadership and concerted effort across the sector for the next decade to deliver world class cancer outcomes and experiences for all Australians (Box 2). Each strategic objective contains a 10-year ambition, and 2- and 5-year goals with associated actions. The strategic objective “Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people” complements the ambitions, goals and actions identified for strategic objectives 1–5, which apply to all Australians including Aboriginal and Torres Strait Islander people. Of the 46 actions in the Plan, all are relevant to Aboriginal and Torres Strait Islander cancer control and a third are Aboriginal and Torres Strait Islander specific. Through identified activities, the Plan addresses contemporary, critical issues relevant to national level cancer control initiatives. These include health literacy,8 particularly for Aboriginal and Torres Strait Islander people and other priority population groups, and health emergency preparedness arrangements,4, 9 to mitigate and manage the impacts of public health emergencies including pandemics, extreme weather events, and other consequences of climate change on cancer control, care and service delivery.10-13 The Plan both leverages and supports existing national health strategies, together with other national, state and territory strategies supporting priority populations. Ensuring equity and access for all and aligning with existing plans to achieve national health goals is in line with calls from international cancer control peak bodies,3, 14 including the World Health Organization's 2017 resolution on cancer prevention and control.15 The Plan will be reviewed after the 2-year and 5-year marks against the actions and goals set out to achieve the strategic objectives. Further actions may be considered for each strategic objective to ensure the Plan is on track to ultimately meet its 10-year ambitions and achieve the envisaged future state of cancer control in Australia. The delivery of the Plan is an important milestone in cancer control policy for Australia. The Plan sets a national reform agenda to accelerate world class cancer outcomes and improve the lives of all Australians affected by cancer, so that everyone with a cancer diagnosis will experience their care free from discrimination and be served by a system that respects them personally, including their culture, age, gender, sexual orientation, health status, and education level. Successful implementation of national cancer control depends on collaborative partnerships.16, 17 Implementation of the Plan is a shared responsibility and will require joint efforts from the entire cancer control sector. An implementation plan has been developed and will continue to evolve over the 10-year life of the Plan. Cancer Australia has invited, and continues to consult with, partners from across the Australian cancer control sector to consider their contribution to this national reform agenda and commit to actions to achieve the Plan's goals. Leadership on priority national actions will come from partners such as governments, non-government organisations, Aboriginal and Torres Strait Islander Community Controlled Health Services and health organisations, and the health and research sectors. In line with implementation, the Australian Government has committed to prioritise and reorient existing programs, where appropriate, to ensure they are closely aligned with the Plan. Cancer Australia will support stakeholders to set common measures and build data collection capacity; will seek and share innovation including the rapid translation and application of research and evidence in all forms; and will identify, advocate for, and action shared priorities that require national approaches. All involved in Australia's cancer control sector are invited to partner with the Australian Government and each other in pursuit of this ambitious national reform agenda. Cross-sector partnerships focused on achieving the Plan's goals and ambitions will engender an integrated, accessible, equitable, and high quality cancer care system committed to world class cancer outcomes for all Australians affected by cancer. This work was funded by Cancer Australia and the Department of Health and Aged Care – Australian Government. Cancer Australia owes a debt of gratitude to the numerous stakeholder organisations and people who contributed to the Australian Cancer Plan either by way of submissions and/or by attendance at workshops and other public forums. We give particular thanks to all the cancer consumers who generously gave their time and experience to help us ensure the patient is at the very centre of this Plan. No relevant disclosures. Not commissioned; externally peer reviewed.