Benitez-Fuentes Javier-David, Lastra Del Prado Rodrigo, Borregon-Rivilla Miguel, de Luna Aguilar Alicia, Lazaro-Sanchez Antonio-David, Ferrández-Arias Asia, Rodríguez Payá Paula, Grau Mirete Beatriz, Quintanar Verduguez Teresa, Asensio Martinez Elena, Iranzo Patricia, Callejo Ana, Cruellas Lapeña Mara, Gómez Ulla Jacobo, Rodriguez-Lescure Alvaro
Department of Medical Oncology, FISABIO, Hospital General Universitario de Elche, Alicante, Spain.
RIO Working Group, Zaragoza, Spain.
Cancer Control. 2025 Jan-Dec;32:10732748251363701. doi: 10.1177/10732748251363701. Epub 2025 Jul 30.
Despite significant advances in oncology, cancer care globally continues to face critical challenges, including stark disparities in access, insufficient preventive focus, fragmented primary health care (PHC) integration, unsustainable financing models, workforce shortages, and inadequate community involvement. This paper revisits the Alma Ata Declaration's principles-health equity, universal access, preventive care, and community participation-as a conceptual framework to address these persistent issues in cancer care. We highlight opportunities to strategically integrate oncology services within strengthened PHC systems, balancing centralized specialist resources with decentralized community-based care. Evidence from diverse settings illustrates how reinforcing PHC infrastructures enhances preventive measures, early detection, and survivorship care, thus mitigating geographic and socioeconomic disparities. Sustainable financing mechanisms and targeted workforce strategies, including task-shifting and multidisciplinary training, are proposed as essential components. Effective community engagement models demonstrate improved care relevance, acceptance, and outcomes. Additionally, we emphasize the critical role of health policy alignment with universal health coverage objectives, robust pharmacoeconomic evaluations, and evidence-based national cancer control plans. Integrating Alma Ata's principles into contemporary oncology provides a viable, scalable model to advance equitable, accessible, and sustainable cancer care globally, laying the theoretical groundwork for future research initiatives and informed policy development.
尽管肿瘤学取得了重大进展，但全球癌症护理仍面临严峻挑战，包括获得医疗服务的巨大差距、预防关注不足、初级卫生保健（PHC）整合碎片化、不可持续的融资模式、劳动力短缺以及社区参与不足。本文重新审视了《阿拉木图宣言》的原则——健康公平、普遍可及、预防保健和社区参与——作为解决癌症护理中这些长期问题的概念框架。我们强调了在强化的初级卫生保健系统内战略性整合肿瘤学服务的机会，平衡集中的专科资源与分散的社区护理。来自不同环境的证据表明，加强初级卫生保健基础设施如何增强预防措施、早期检测和生存护理，从而减轻地理和社会经济差距。提出可持续的融资机制和有针对性的劳动力战略，包括任务转移和多学科培训，作为重要组成部分。有效的社区参与模式显示出护理相关性、接受度和结果的改善。此外，我们强调卫生政策与全民健康覆盖目标保持一致、强有力的药物经济学评估以及基于证据的国家癌症控制计划的关键作用。将《阿拉木图宣言》的原则融入当代肿瘤学提供了一个可行、可扩展的模式，以在全球推进公平、可及和可持续的癌症护理，为未来的研究倡议和明智的政策制定奠定理论基础。
