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| Fig. 1: IAEA Logo. (Source: Wikimedia Commons) |
The International Atomic Energy Agency (IAEA) (see Fig. 1) is an international organization that serves 172 of the world's countries to promote safe, secure and peaceful use of nuclear energy. [1] Fig. 2 shows the current IAEA Member States. Nuclear energy has a variety of important uses in electricity generation, medicine, industry, agriculture, as well as in our homes. There are many applications of radiation in the medical field, ranging from diagnostics, to treatment and disease management. Radiation therapy, often referred to as radiotherapy) is an approach to treating cancer, along with other treatment options, like chemotherapy and surgery, that can control symptoms, kill cancer cells, and shrink and stabilize tumors. The IAEA acknowledges the prevalence of cancer in the world, especially in low and middle income (LMI) countries. Millions of people in LMI countries are dying from cancer each year even though many of their deaths could have been prevented if detected and treated earlier. It is estimated that nearly 70% of cancer patients in LMI countries are diagnosed too late for curative treatment to remain an option. [2] Early detection programs for cancer are largely inaccessible or unavailable in many developing countries. According the International Agency for Research on Cancer (IARC), 18 million people around the world developed cancer and 9.5 million died from the disease in 2018. By 2040, these annual figures are expected to increase by a third, with the greatest impact on LMI countries. The rising rates of cancer in the world and the increase in fatalities in LMI countries represent an urgent challenge for public health decision-makers and cancer care providers.
In order to address the pressing cancer crisis, the World Health Organization (WHO) suggests that countries develop a National Cancer Control Programme (NCCP) which empowers countries to to take a systematic and comprehensive approach to ensure best practices. The WHO defines an NCCP as a public health programme designed to reduce cancer incidence and mortality and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources. [3] The IAEA offers its Member States a service called the imPACT (integrated mission of PACT) Review, through its Programme of Action for Cancer Therapy (PACT). It provides a comprehensive approach to conducting a needs assessment of a country's cancer control infrastructure and capacity which is the first step in addressing the cancer burden of Member States based on a comprehensive and long term sustainable approach. [2]
Commitment from Member States is critical in ensuring that the review will be implemented. The imPACT review process can last between 18 to 24 months from the initial request to the submission of the final report and recommendations for action by the government, endorsement of the recommendations and initiation of implementation in the context of an NCCP. [2] An IAEA member state is only eligible for an imPACT review if:
Cancer is recognized as a public health priority in the country and national health authorities are committed to address cancer control.
National health authorities have formally requested IAEA assistance on cancer control.
The Member State is a recipient of the IAEAs Technical Cooperation (TC) Programme with active radiotherapy project(s) or has plans to establish a radiotherapy programme. [2]
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| Fig. 2: IAEA Member States (green). [1] (Source: Wikimedia Commons) |
Once the initial request is submitted and accepted, the imPACT review can begin. Beginning in 2020, the IAEA and its partners adapted to the COVID-19 pandemic by offering virtual assessments. The IAEA carries out a comprehensive assessment of the country's cancer control capacity, a capacity and needs assessment for the effective implementation of the country's radiation medicine programme, assists in the planning of the country's cancer related IAEA/TC projects for future cycles, and explores cancer control needs that can be addressed through project proposals and multidisciplinary assistance packages through external funding. An imPACT Review mission report is compiled, endorsed by the IAEA, WHO, and IARC and then sent to the recipient Member States Ministry of Health.
Following the official endorsement of the imPACT Review mission reports recommendations, it is expected that cancer control activities are planned, developed and evaluated in accordance with the recommendations for Member States. They should be able to develop appropriate strategies, action plans and project proposals for the expansion of national cancer control capacity and infrastructure. More specifically, the implementation of imPACT recommendations is expected to lead to several key outcomes for developing comprehensive cancer control services based on government priorities, including:
Establishment of a National Cancer Control Steering Committee involving all stakeholders. The Committee will be responsible for developing the NCCP.
Development of an NCCP following WHO guidelines and national characteristics. This will help reduce cancer incidence and mortality while improving the quality of life of cancer patients and help countries make the best use of available resources.
Development of a 10-year Action Plan with ranked priority activities, realistic goals, timeframes, milestones and estimated budget, with their radiation medicine plan as an integral piece.
Development of specific funding proposals, for short-, medium- and long- term assistance packages/projects to meet the country's specific needs covering each component of cancer control.
Through PACT, the IAEA focuses on reviewing national capacities for cancer control, supporting national cancer control planning and mobilizing additional resources and partnerships. ImPACT review missions pull together the IAEA, WHO, IARC, the Union for International Cancer Control (UICC) and many other relevant collaborators to build a coalition of global partners committed to addressing the challenge of cancer in low and middle income IAEA Member States. In 2020, ImPACT Reviews were conducted for the Central African Republic, Mali and Senegal, using a hybrid physical virtual format and three other Member States initiated missions. [1] Over the past 20 years, the IAEA has conducted over 100 imPACT reviews in more than 91 countries with the goal of supporting the planning and decision-making needed for national cancer control activities. Although the IAEA had an operational budget of €377.4 million in 2020, the budget for the coordination of and support to the PACT was only €2.5 million which was less than 1% of IAEA's overall spend. [4]
© Lexie Hull. The author warrants that the work is the author's own and that Stanford University provided no input other than typesetting and referencing guidelines. The author grants permission to copy, distribute and display this work in unaltered form, with attribution to the author, for noncommercial purposes only. All other rights, including commercial rights, are reserved to the author.
[1] "IAEA Annual Report 2020," International Atomic Energy Agency, 2020.
[2] "imPACT: Integrated Missions of PACT," International Atomic Energy Agency, 2013.
[3] National Cancer Control Programmes, 2nd Ed. (World Health Organizataion, 2002).
[4] "The Agency's Programme and Budget, 2020-2021," International Atomic Energy Agency, July 2019.
