118 Planning and implementation of a cancer control program with integration of primary health care and palliative care services in a low middle income country

Background Cancer, the second leading cause of death globally, accounted for an estimated 9.6 million deaths in 2018. More than 70% of all cancer deaths occur in low and middle income countries, where resources available for prevention, diagnosis and treatment of cancer are inadequate with limited health care infrastructure and competing health care priorities. Kerala, a state in South India, has higher than Indian average of social and health indicators like education, life expectancy, maternal and infant mortality, with well-integrated primary health care and palliative care services. Palliative care in the state has grown to be a sustainable model recognized in global palliative care and public health scene. We describe an approach that integrates cancer prevention, early detection and supportive care by utilizing the services of existing primary health and palliative care. Methods We planned and executed the program funded by local-self-government over a period from July -December 2019, which targeted three common cancers, breast, cervix and oral cavity. The strategies implemented include; improving cancer literacy among the public to encourage self-referral, and awareness of early warning signs of cancers among primary care physicians, also to empower specialists in diagnostic procedures, prompt referral and timely initiation of treatment and integrate cancer surveillance with palliative care network. Results The program was able to train about 700 healthcare workers and 70,000 members of public. There were 575 biopsies performed over 6 months out of which 53 were malignant, 8 premalignant. Median age of diagnosis was 60, 55% were female. 48% of the total cancer diagnosis was oral cancer. The median time of availability of biopsy report was 6 days. 86% of patients with a cancer diagnosis was contacted by community palliative care nurse at diagnosis. Conclusion Palliative care and primary care services can be successfully integrated into Oncology practice. Further research is planned to evaluate the long term goals of down-staging cancer, reducing the time period from diagnosis to treatment and improvement of cancer care outcome.