INDONESIAN CANCER CONTROL PROGRAMs

(ICCPs) 2010-2014

WHO highly
recommendation

Background
The global burden of cancer continues to increase largely because of the aging and
growth of the world population alongside an increasing adoption of cancer-causing
behaviors, particularly smoking, in economically developing countries. Based on
the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6
million cancer deaths are estimated to have occurred in 2008; of these,
56% of the cases and 64% of the deaths occurred in the economically
developing world. (CA Cancer J Clin 2011;61:6990)
There are 3.6 million males and 4.0 million females living with cancer in these
Asian countries. In most of the Asian countries, cancer of the colon and rectum is
the mostcommon among male cancer survivors; among female survivors, breast
cancer is the most common in most Asian countries.
GLOBOCAN estimated 292.629 cancer cases and 214.626 cancer deaths in
Indonesia in 2008.

Following Minister of Health Decree No. HK.03.01/160/I/2010 about

Strategic Planning of Ministry of Health 2010-2014, Ministry of Health has

developed National Plan on Cancer Control, named Indonesian Cancer
Control Program (ICCP) 2010-2014.

Definition

WHO defined National Cancer Control Program is a public

health program designed to reduce the number of cancer
cases and deaths and improve quality of life of cancer
patients, through the systematic and equitable

implementation of evidence-based strategies

for prevention, early detection, diagnosis, and palliation,
making the best use of available resources.

A comprehensive national cancer program evaluates the

various ways to control disease and implements those
that are the most cost-effective and beneficial for the
largest part of the population. It promotes the
development of treatment guidelines, place emphasis on
preventing cancers or detecting cases early so that they can
be cured, and provide as much comfort as possible to
patients with advanced disease.

Strategy (to be adopted)

Global Strategy

WHA Resolution

1. To collaborate with the Organization in developing and reinforcing

comprehensive cancer control programmes
2. To set priorities based on national burden of cancer
3. To integrate national cancer-control programmes in existing health
systems
. WHO Guideline on Cancer Control

1.
2.
3.
4.
5.

Prevention
Early Detection
Diagnosis and Treatment
Cancer Surveillance
Research: (Lab, Epidemiological, Clinical, Psychosocial and behavioral,
health system and health policies)
6. Palliative Care
7. Support and Rehabilitation
. World Cancer Declaration (UICC)

Priority action:
1. Health Policy
2. Cancer Prevention and Early detection
3. Cancer Treatment

Existing Cancer Control Program

Prevention
-Guidelines of risk factors
control
-Promotion and Campaign
on cancer prevention
-Advocating tobacco
control

Early Detection
-Female Cancer Program
(FcP) has developed
cervical and breast cancer
screening program
(opportunistic)

Diagnosis and
Treatment
- 14 Center of Pathology
- 10 Center of Radio
Oncology
- 21 Center of
Radiotherapy
- 16 LINAC, 17 Telecobalt

Surveillance and Registry

Semarang pop based CanReg (1970)
Pathological based in 13 Pathology center (1987)
Hosp based CanReg in 40 Hospitals (as model) in
Jakarta
(2006-2009)
Jakarta Cancer Registry (2009 now)

Palliative Care
-Guideline of Palliative
care in hospital

Research
-Riskesdas

Support and
Rehabilitation
-Free homestay and
education for childhood
cancer patients (NGOs,
group of survivors)

Launching of

National Cervical & Breast Cancer Screening Program

By Indonesian First Lady, 21 April 2008

Vision and Mission

Vision:
Self motivated people to live healthy life
without cancer
Mission:
1. Increase Indonesian People health status
through community empowerment
2. Protect Indonesian people from cancer by
providing comprehensive, distributed,
high quality, and equal health care
3. Ensure availability and distribution of
human resources of cancer control
4. Create good governance on cancer

Goal and Objective (1)

Goal:
To enhance cancer prevention and control in Indonesia
Objective:
1. Reducing the overall incidence and impact on the
Indonesian population
2. Reducing health inequalities relating to cancer and
barriers to cancer services by providing access
especially for poor people
3. Strengthening health promotion so that as many of
the population as possible enjoy cancer-free lives
4. Ensuring timely diagnosis for those with cancer and
timely access to high-quality care throughout their
experience of cancer
5. Assisting those with cancer, their families to fully
participate in all decision making related to their

Goal and Objective (2)

Goal:
To enhance cancer prevention and control in Indonesia
Objective:
6. Ensuring careful planning and appropriate priorities
by making the best use of existing resources and
identifying where additional resources are needed
7. Ensuring the effectiveness of cancer control
through research activities
8. Furthering the development of the cancer control
workforce and increasing specialist training
opportunities
9. Regularly monitoring cancer control activities to
ensure they are effective and remain effective
10.Regulating of nuclear energy use on cancer
diagnostic and therapy

Indonesia Cancer Control

Program 2010-2014
1. Prevention
2. Early detection and screening
3. Diagnosis and Treatment
4. Surveillance and Cancer Registry
5. Research
6. Palliative Care
7. Support and Rehabilitation

Early detection and screening

Objective:

To strengthen effort on cancer prevention through legal approach

behavioral change, vaccination, local participation, and community
empowerment.

rogram :
1

Strengthening policy
and commitment

The commitment will be developed by advocacy attended by

all stakeholders.

Promotion and
Campaign

Should be done massively and continually. Distributed to all

province in Indonesia and publish in electronic media.

Development of
Guideline

Review and improve national guideline of cancer control and

develop technical guideline of risk factor control, community
empowerment, and cancer prevention.

Human Resources
Development

Hold training of cancer control management and cancer

preventive promotion also technical assistant for cancer
control provider.

Partnership

Consist of government - non gov sector in international,

national province and municipality level.

Community
Empowerment

Will train cadres in cancer prevention strengthening PosKesDes

and PosBinDu

Insurance

Try to include the vaccination in insurance

Planning Process

Will hold meeting, workshop, and socialization on developing

plan on cancer prevention and control
All existing cancer control activities will be controlled and

Diagnosis and Treatment

Objective:
To provide affordable, high quality, distributed diagnosis and treatment
facilities to all cancer patients in Indonesia
rogram :
The assessment will cover human resources, drug
1 Assessment
availability, and facility & equipment

Strengthening policy

Nat guideline of diag and treat, cancer services and hosp

stratification

Supply of diagnostic
and treatment facilities

a. Diagnostic facility (Rad, Nuclear med, Path, Mol diag,

Lab)
b. Treatment facility (Surge, Radth, Chem, Nuc med) Intl
standart
c. a dan b with WHO prequalification
d. Brachytherapy
e. Research on a.b.c.d

Supply of affordable
drug of cancer

Get adequate medication quality and quantity

Regulating of nuclear
energy use

License of nuclear energy use (QA-QC) by BAPETEN

Calibration and
Standardization

All facility in diagnostic and treatment will be calibrated and

standardized

Clinical training and

research program

HRD should be trained well

4. Surveillance and Cancer Registry

Objective:
To develop sustainable cancer surveillance and use its results as
source of information on planning, monitoring, and evaluating cancer
control program.
Program :
1

Establishing legal
aspect

Ministry of Health Decree of National Cancer Registry

team and Provincial health office decree on
provincial/Regional Cancer Registry team

Developing guidelines

Develop guidelines of cancer registry, modules of

cancer registry trainings and instrument of monitoring
and evaluation

Developing National
Cancer Surveillance
and Registry

- Establish National Cancer Registry team and 12

Regional Cancer Registry team
- As part of Non Communicable Disease (NCD) Control,
surveillance cancer will be a part of NCD surveillance.
We will develop surveillance of tumor integrated NCD
surveillance

Human Resources
Development

- Capacity building of CanReg (management and

operational)
- MOT National Cancer Registry
- Training of CanReg
- Training of Surveillance of tumor (integrated NCD
surveillance)

Networking

- International (IARC and IACR)

- Regional Asia Pacific (Asian Cancer Registry Network)
- National (National network on Cancer Registry)

Developing
National Cancer
Surveillance and
Registry

DG of Health Effort
Care,
Ministry of Health

National Cancer
Control Institute
Division of Cancer
Registration and
Surveillance

Jamkesm
as
- Askes
Jamsoste
k

Dinas Kesehatan
Primary
Health
Care

Hospitals

Clinics
Insurance
s

DG of Disease
Control and
Environmental
Health,
Ministry of Health

POPULATION
BASED
CANCER
REGISTRIES

Traditiona
l Medicine
(BATRA)

Cancer registration may be defined

as the
process of continuing, systematic collection
of data
on the occurrence and characteristics of
reportable
neoplasm
Cancer registry is in the office or
institution which attempts to collect, store,
analyze

The main objective of the cancer

registry
To collect and classify information on
all cancer cases in other to produce
statistics on the occurrence of cancer
in a defined population and
To provide a framework for
assessing and controlling the impact
of cancer on the community

The Role of Cancer Registries

in Cancer Control Program
The cancer registry is an essential part of
any rational program of cancer control.
Its data can be used in a wide variety of
areas of cancer control ranging from etiological
research, through primary and secondary
prevention to health-care planning and patient
care.

Ministry of
Health

Ministry of
International Collaboration
Education
National Program, Research, Education
University Society in
in Cancer
Indonesia
National Tumor Board
Education Curriculum

Dharmais Cancer
Hospital / National
Cancer Center
Research Cancer Center
2012
Advisory
Committ
ee

National Cancer Registry

(Urban
Area)
Comprehensive
Cancer

Faculty of Medicine
(S1,S2,S3)
Faculty of Public Health
(Majoring
Cancer Epidemiology)
Faculty of Nursing (Oncology
Nurse)
Indonesian Oncology Society
(POI)

Center
2014

Dissemination

National Cancer Registry

(Pilot Project
in Rural Area)

National Cancer Center

2015-2019
Research Ethics
Committee

National
Cancer
Researc
h
Foundat
ion

National
Cancer
Research
Center

Affiliated
Hospitals
(10
Centers
in
Regional
)

Board
Division of
Committee
National
Cancer
Division of
Registration
Education and
(Urban-Rural
Training
Area)

and

Certified Cancer
Education
Training & Education

Board Committee

Division of
National Cancer
Registration
(Urban-Rural
Area) and
Surveillance

Cancer Registry
Society
University Society
Cancer Registry
Network

Sub Division
Of Regional Rural
Area

Sub Division
Of Regional Urban
Area

Coordinator Regional
Rural I
(West Indonesia)
Coordinator Regional
Rural II
(Central Indonesia)
Coordinator Regional
Rural III
(East Indonesia)

Coordinator Regional
Urban I
(West Indonesia)
Coordinator Regional
Urban II
(Central Indonesia)
Coordinator Regional
Urban III
(East Indonesia)

Pre-clinical phase
------------------------------------

Onset of
Exposur disease
e
A

Primary
prevention

Clinical
phase
-----------------------------------------------------------

Onset of
symptoms
Early
detectio and/or
signs
n
D1
Cure
B
C
D2
Disability
D3
Death
Secondary Tertiary
prevention prevention

5. Research
Objective:
To obtain scientific information on cancer as evidence of cancer
control program in all aspect
Program :
1

Legal aspects

Develop ethical board

HRD

Establish Board of Cancer Research

Developing
guideline

Policy, strategy, and priority of research on

cancer

Research on Cancer
Epidemiology

Will be connected to cancer registry or

independently. Focus on risk factors,
implementation HPV vaccination, survival,
cervical and breast cancer, cause of deaths.

Research on
Molecular
Epidemiology

Focuses in 10 top leading cancer in Indonesia

Clinical Trial

Developed on top 10 leading cancer

Partners
International Organizations:
- UICC (Union International Cancer Control)
- WHO (World Health Organization)
- IAEA (International Atomic Energy Agency)
- IARC (International Agency for Research on Cancer)
- IACR (International Association of Cancer
Registries)

Indonesian Government:
-

Ministry of Education
Ministry of Religion
Ministry of Research and - Technology
National Atomic Energy Agency (BATAN)
Nuclear Energy Regulatory Agency (BAPETEN)

Non-Governmental Organization
-

YKI (Yayasan Kanker Indonesia)

PKTP (Pengendalian Kanker Terpadu Paripurna)
YKAKI (Yayasan Kasih Anak Kanker Indonesia)
YOAI (Yayasan Onkologi Anak Indonesia)
MPI (Masyarakat Paliatif Indonesia)
FcP (Female Cancer Program)
CISC (Cancer Information and Support Center)
JHPIEGO (Alliance of Jhon Hopkins University)

Professional
Societies:
POI
POGI
HOGI
PORI
PDSRI
PDPI
PDPI
PERABOI

IAPI
JNPK
IDI
IBI
PPNI
HOMPEDIN
IKAFMI
PKNI
IAKMI

The Declaration calls on the world to

take immediate steps to reduce the
global cancer burden by committing to
the 11 Declaration targets and
providing resources and political
backing for the priority actions need to
achieve them.
http://www.uicc.org/declaration/signdeclaration-thx

Thank