The IARC Initiative for Resilience in Cancer Control (IRCC) is a collaborative project that aims to investigate the impact of health crises on cancer services, including health system disruptions and mitigation strategies.
 

Why this research is important

The COVID-19 pandemic underscored the vulnerabilities inherent in health systems worldwide, particularly in low- and middle-income countries, where cancer services faced significant disruptions. These services, already strained, were further compromised by systemic limitations, including inadequate health-care infrastructure, a scarcity of essential medical supplies, and a shortage of trained personnel.

The association between the increased impact of the COVID-19 pandemic on disruptions in cancer care services and income inequalities highlights that the pandemic disproportionately affected marginalised groups, such as low-income populations. Disruptions in cancer care are not isolated events. The repercussions of delays in cancer diagnosis and treatment are expected to have long-lasting consequences. Projections indicate that the impacts on morbidity and mortality will persist into the next decade.

The COVID-19 pandemic is just one of multiple health crises that the global cancer community has faced in recent decades. Low- and middle-income countries experience the highest number of health crises, including natural disasters, humanitarian crises, and disease outbreaks – often occurring simultaneously – that cause the collapse of health systems in affected countries and overwhelm neighbouring countries and regions. In such challenging contexts, the urgent need to strengthen health system resilience and ensure the continuity of cancer control during health crises has become increasingly evident.

Aims

The main objectives of the IRCC are:

1. Conduct in-depth monitoring of key indicators of cancer incidence, survival, and mortality before, during, and after health crises.
   
   
2. Explore reasons for disruptions to cancer services and mitigation strategies used during health crises, emphasizing the importance of the local context.
   
   
3. Provide tools to model the short-, medium-, and long-term impact of disruptions on cancer outcomes, to improve resilience in cancer control.

Programme of work

The IRCC’s programme of work follows three overarching aims.

1. Conduct in-depth monitoring of key indicators of cancer incidence, survival, and mortality before, during, and after health crises.

Driven by data collected by population-based cancer registries, the IRCC’s first aim encompasses population-based studies focused on the following themes:

• Impact of health crises such as the COVID-19 pandemic on cancer diagnosis and stage;
• Cancer survival before and during the COVID-19 pandemic;
• Global impact of the COVID-19 pandemic on cancer mortality.

2. Explore reasons for disruptions to cancer services and mitigation strategies used during health crises, emphasizing the importance of the local context.

The IRCC’s second aim encompasses activities focused on the following themes: 

• Impact of health crises including the COVID-19 pandemic on delays and disruptions in cancer services;
• Impact of COVID-19 mitigation strategies on disruptions in cancer services;
• Health system responses and stakeholder experiences during health crises;
• Health systems resilience in coordinating cancer control during health crises in low- and middle-income countries.

3. Provide tools to model the short-, medium-, and long-term impact of disruptions on cancer outcomes, to improve resilience in cancer control.

The IRCC’s third aim continues to develop as findings become available from the first two workstreams. Current developments encompass the following:

• The Cervical Cancer Elimination Planning Tool (EPT) enables countries to create effective, sustainable cervical cancer strategies that are specific to their unique demographic and health-care needs. The tool includes features for countries to plan and mitigate delays in the rollout of the three pillars of the World Health Organization (WHO) Cervical Cancer Elimination Initiative.
• A second tool, as an expansion of the EPT, will be designed around the four functions within the WHO framework for health system performance assessment: governance, financing, resource generation, and service delivery.

Research team

The IRCC is led by Dr Isabelle Soerjomataram, Deputy Head of the Cancer Surveillance Branch at the International Agency for Research on Cancer (IARC).

The members of the IRCC research team are:

• Harriet Rumgay (Cancer Surveillance Branch, IARC) 
• Heloise Agreli (Cancer Surveillance Branch, IARC) 
• Yann Becker (Cancer Surveillance Branch, IARC) 
• MengMeng Li (Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China)
• Max Parkin (Cancer Surveillance Branch, IARC) 
• Marion Piñeros (Cancer Surveillance Branch, IARC) 
• Amanda Ramos da Cunha (Cancer Surveillance Branch, IARC) 
• Ceren Süngüç (Cancer Surveillance Branch, IARC)
• Katiuska Veselinovic (Cancer Surveillance Branch, IARC) 
• Ariana Znaor (Cancer Surveillance Branch, IARC) 

This IRCC research team is supported by the Scientific Advisory Board:

• Karima Bendahhou (Registre des Cancers du Grand Casablanca, Morocco)
• Phiona Bukirwa (Makerere University, Uganda)
• Karen Canfell (Cancer Council New South Wales, Australia)
• Karen Chiam (The Daffodil Centre, Australia)
• Sultan Eser (Izmir Cancer Registry, Balikesir University, Balikesir, Türkiye)
• José Leopoldo Ferreira Antunes (University of São Paulo, Brazil)
• Freddy Gnangnon (Registre des Cancers de Cotonou, Benin)
• Phoebe Mary Amulen (Kampala Cancer Registry, Uganda)
• CS Pramesh (Tata Memorial Hospital, Parel, India)
• Mazvita Sengayi-Muchengeti (National Cancer Registry of South Africa)
• Richard Sullivan (King’s College London, Institute of Cancer Policy, United Kingdom)