In a recently published special article in JCO Global Oncology, the authors present City Cancer Challenge’s (C/Can) framework for strengthening cancer care in cities in low- and middle-income countries (LMICs) and explain how it is implemented. C/Can, an ASCO partner, supports cities around the world in improving access to equitable, quality cancer care. The first city to join the challenge was Cali, Colombia, and the paper details lessons learned from implementing and applying the framework in this city of more than 2 million people.

“The experience in Cali has served to reaffirm C/Can’s approach and sharpened our understanding of where C/Can adds unique value—through its efforts to fuel city innovation and leadership based on local investment in the people with the knowledge, insights, and data of the situation in the city, as well as support through a global network of partners, bringing together governments, the international community, civil society, and the private sector,” C/Can’s Policy and Global Impact director Rebecca Morton Doherty said. “This catalytic support in local investment and leadership can generate exponential value, as the experience from Cali has demonstrated.”

The authors explain that using implementation science to improve health care practice and delivery has been a growing field over the past decade. However, in cancer, most of the data and evidence comes from well-resourced, high-income cities. Only recently have adaptations been proposed for making the framework scalable for low- and middle-income countries.

C/Can aims to develop and test innovative approaches to addressing cancer care gaps in cities in LMICs. Local stakeholders in the participating city lead a multistage, city-wide process to assess, plan, and execute the cancer care solutions adapted to that locale over a period of 2 to 3 years.

“Starting first in a small number of cities in LMICs, C/Can’s City Engagement Process Framework (CEPF) has been progressively tested and adapted to resource-constrained environments through this ‘learning by doing’ approach, with the early learning now informing the process in new cities,” the authors write. “Designed to engage local stakeholders in the planning and execution of projects that respond to local priorities in cancer diagnosis, treatment and care, the C/Can CEPF incorporates key elements of existing implementation science frameworks … [and] also draws on the systems-wide, inclusive and collaborative approaches that have proven effective for other conditions such as HIV/AIDS.”

The authors noted that partnerships with health professional associations, including ASCO, are crucial for responding to local needs, including increasing the ability to deliver multidisciplinary cancer management. C/Can also has relied on ASCO guidelines, including those regarding treatment and management of breast and cervical cancer, for the implementation phase. ASCO also has trained more than 120 health care professionals in the C/Can cities of Asuncion, Cali, and Yangon through its Multidisciplinary Cancer Management Courses.

Read the full JCO Global Oncology special report.

Read more about C/Can’s work in the JCO Global Oncology commentary “Cities as an Enabler for Strengthening Cancer Care.”

View ASCO’s quality care resources for providers outside the U.S.