Implementation Research to Enhance Screening, Early Diagnosis and Initiation of Treatment for Oral, Breast and Cervical Cancer in Selected Districts of India

Background: Despite the implementation of the National Programme for Prevention and Control of

Non-Communicable Diseases (NP-NCD), the coverage of screening for oral, breast, and cervical

cancers remains significantly low. Further there is a delay in diagnosis and treatment initiation.

Strengthening health systems is vital for providing accessible preventive cancer care. There a

scarcity of comprehensive studies assessing barriers and enablers of cancer screening, facility

readiness for cancer care and identifying referral barriers from primary to advanced care.

Objectives: This multisite study is designed within the context of NP-NCD in seven Indian districts

across seven states with the following objectives: I) Assess current status, barriers, and facilitators

in cancer screening, diagnosis, and treatment initiation; (II) Co-develop and optimizing the

implementation model based on key performance indicators in sub-district populations; (III)

Implement and evaluate the model across districts to recommend broader applications.

Methods: Utilizing a mixed-method implementation research design, the study will analyze

screening, diagnosis, and treatment coverage for the three cancers and their determinants. It will

also assess a proportion of facilities providing care for cancer at various levels and explore the

cancer care pathway.  A combination of quantitative surveys, qualitative interviews, and facility

assessments will be used for baseline assessment and then to evaluate the outcomes. The study

population will include a subset of the target population in the selected districts, health care

providers (ASHA/ANM/CHO/MO, specialist), program officers, voluntary organizations, cancer

patients and their caregivers.

Discussion: Based on the baseline assessment in Phase I, an evidence-based implementation

model will be co-developed and iteratively optimized with various stakeholders from the state,

district and community. This model would be implemented and further optimized during Phase II.

The final model will be implemented across the districts to enhance the coverage of cancer

screening, early diagnosis and treatment initiation in the targeted districts in Phase III.