Impact and Evaluation of International Cancer Control Congresses

The ICCC4 followed three ICCC meetings that were held; Canada in 2005, Brazil in 2007, and Italy in 2009, respectively. Although the earlier Congresses had not conducted formal evaluations with the exception of ICCC3, the 4th Congress placed evaluation in a principal role; that of helping design the Congress, monitor the implementation, assessed the participants on their backgrounds, interests, query local hosts, and assess attendees. A logic model was created to provide a framework for general concepualization, as well as for planning logistical operations. One of the results was the dedication of a major session on evaluation at the Congress. Broadly, the session contained an overview of the importance of evaluation in cancer control and in the Congresses, the results of the evaluation of ICCC3, the loco-regional impact of one of the earlier Congresses followed by a moderated discussion, and included a handson real time evaluation session.


Introduction
The ICCC4 followed three ICCC meetings that were held; Canada in 2005, Brazil in 2007, and Italy in 2009. Although the earlier Congresses had not conducted formal evaluations with the exception of ICCC3, the 4th Congress placed evaluation in a principal role; that of helping design the Congress, monitor the implementation, assessed the participants on their backgrounds, interests, query local hosts, and assess attendees. A logic model was created to provide a framework for general concepualization, as well as for planning logistical operations. One of the results was the dedication of a major session on evaluation at the Congress.
Broadly, the session contained an overview of the importance of evaluation in cancer control and in the Congresses, the results of the evaluation of ICCC3, the loco-regional impact of one of the earlier Congresses followed by a moderated discussion, and included a handson real time evaluation session.
Although evaluation of conferences and meetings is relatively routine, few address the basic issues of whether the event was worth having, and whether it had meaningful short and long term impact. Most conference evaluations dwell on satisfaction with the venue, the presenters, logistics, the quality of materials, and many seek suggestions for improvement. Some collect information on what was learned (www.ncil. org/conference/2010evaluations.html) and others deal with sponsors, exhibits, and costs (www.jamorell.com/ documents/How_to_Evaluate_a_Conference-1.pdf), and others deal with how information was learned. Some have incorporated technology (www.thinkbiznw.com/2011/09/ new-way-to-evaluate-conference.html), although the large majority use paper. Nearly all occur at a single point in time, usually at the end of a session or the end of the conference.
For the International Cancer Control Congresses, which have been held biennially, formal evaluations have begun to play an increasingly important role over time. At the ICCC4, held November 3rd to 5th, 2011 in Seoul, Republic of Korea, an evaluation approach was developed which may serve as a model for other international conferences.
The approach included development of a logic model, which links the vision for the Congress, the goals, the approach, the guiding principles, the substantive areas addressed, the inputs, the strategies, the outputs, and the short, medium and long term outcomes (www.who. int/cancer/modules/Prevention%20Module.pdf). The evaluation focuses its questions on both the specifics of the Congress -whether the goals were met, whether the Congress was implemented as planned, etc., and on whether the Congress results in any short, medium, or long term changes in Comprehensive Cancer Control. It also addresses whether the International Cancer Control Congresses are worthwhile to hold regularly, and the fundamental issue of the value of this international meeting. It assesses what differentiates the Congress from other international cancer meetings. and whether the host country and region experienced any lasting impact in comprehensive cancer control (CCC) from the Congress planning, implementation, and visibility of the issues raised.
The logic model used in ICCC4 is presented above.
The left side of the figure presents a Strategic Plan for ICCC4. It consists of a Vision (Why), Shared Goals, Strategies (What and How), Values (Guiding Principles), Areas of Focus, and the range of disciplines and professionals addressed. The right side of the figure is the logic model itself, and includes Inputs, Strategies, Outputs, and three time-related sets of outcomes. The entire figure needed consensus from those involved with planning, implementing, presenting, and evaluating the Congress. Although a Strategic Plan is commonplace for Corporations, Governments, and Universities, it is rarely applied to conferences or congresses. In contrast, while evaluation is common for conferences or congresses, it seldom uses a logic model, and if it does, it is unusual for it to be tied with a Strategic Plan, as well. This logic model follows the SMART (Specific, Measurable, Acheivable, Relevant and Time-Bound) terms (Doran, 1981).

ICCC4 Session 5. Evaluation (www.iccc4.com/
program/program_03_2.asp) The purpose of the session was to conduct a real time evaluation of ICCC4 to determine if the congress achieved its purpose, as well as, to discuss evaluation of the usefulness of international cancer control meetings, with a focus on the ICCC meetings. The discussions ranged from covering the importance and logic of evaluation to discussing the perceived value of ICCC and determining if these conferences lead to increased or changes in activity that advance population-based cancer control and, finally a look at what activities at the congress can increase their value.
The plenary workshop began with sharing a synthesis of learnings from the 3rd International Cancer Control Congress (ICCC3), held in 2009 in Cernobbio, Italy. The presentation, delivered by Kavita Sarwal, presented the results of the evaluation, emphasizing those which had implications which needed to be incorporated into the planning of ICCC4. That is, strengths and weaknesses of ICCC3 were used to plan the development of the ICCC4, and the evaluation of the ICCC4, as well. The title of the presentation was "Synthesis of Learnings from ICCC3". The overall findings were that the: A majority of participants were satisfied with the scientific sessions. There were suggestions of adding more topics to presentations and workshops.
Participants would like to see an increase in the number of workshops and overall session duration.
Changes that were suggested were to add more new content and application examples for each of the scientific session topics.
Participants voiced need for more opportunities for networking and advocated inviting more policy makers to attend and be active in the meeting.
These results were used to inform the planning of ICCC4, to add new plenary speakers, more application examples, new content and global developments, more networking time, increased focus on posters, and panel discussions during workshops.

Panel Discussion: Reflections on the International Cancer Control Congresses
At the ICCC4, the plenary presentation was followed by a panel discussion "Vancouver, Rio de Janeiro, Cernobbio, Seoul: What Have International Cancer Congresses Wrought?" whose discussants were the ICCC4 Host, Dr. Jin Soo Lee (Republic of Korea); the ICCC3 Host, Dr. Renee Otter, representing Dr. Andea Micheli (Italy); Mr. Massoud Samiei, the then Director of the IAEA/PACT Programme Office (Austria); and Dr. You Lin Qiao, Co-Chair of Session 5 (China). Each of these individuals has had a major role in at least one International Cancer Control Congress. Dr. Simon Sutcliffe, President of the International Cancer Control Congress Association, and the Co-Chair of each of the ICCCs, also presented his perspective and shared some viewpoints and facts sent by Brazil , during this panel discussion.
The feedback from the Congress in Brazil informed the planning of the Congress in Cernobbio, which followed in 2009 as the ICCC3. Similarly, the feedback and evaluation from ICCC3 informed the planning for ICCC4. The perspective shared from Brazil spoke to the impact that ICCC2, held in 2007, in Rio de Janeiro, Brazil made on Cancer Control visibility and efforts in and around Brazil. Planning for ICCC2 led by Dr. Santini, Director General INCA Brazil and integrated efforts afterwards resulted in enhanced cancer control activities within the country and regionally. That is, after ICCC1 was held in Vancouver, Canada, representatives from 10 Latin American countries and the Caribbean met twice. The first was an international forum of leaders to broaden knowledge of cancer control, held in Mexico City, in 2006. This meeting included NCI (i.e.,country-wide) directors from several countries, including Brazil, Mexico, Peru, and Uruguay. The purpose of this meeting was for each country to develop a Comprehensive Cancer Control Plan. Countries were assisted by the American Cancer Society, the US National Cancer Institute, the US Centers for Disease Control, and Strategic Health Concepts, Inc.
This was followed by a Workshop held in Rio de Janeiro, in November 2007. The result of these two meetings, and the ICCC2, were the establishment of the Latin American and Caribbean Alliance for Cancer Control, which includes Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, México, Nicaragua, Peru and Uruguay. It also led to the signing of the Rio de Janeiro Declaration (www.inca.gov.br/inca/Arquivos/.../ LetterRiodeJaneiroEnglish.doc), issued collectively by all participants at the closing ceremony of the 2nd ICCC. This Declaration affirmed the need to summon regional forces to work together and promote the precvention and control of cancer. It declared that there needed to be new efforts on joint work between countries on common interests related to cancer prevention and control. The Latin American and Caribbean Alliance for Cancer Control (www.paho.org/english/ad/dpc/nc/pcc-fact-sheet-newalliance.pdf), initiated at that time, was directed to work work closely with the Pan American Health Organization on developing prevention and control interventions. The Alliance is a key forum for the implementation of the cancer plan of action.
The ICCC also revitalized Latin American participation in the Red Ibero-Americana de Control del Tabaquismo (RIACT)] (www.inca.gov.br/arquivo/riact. pdf); encouraged a series of measures by South American countries in tobacco control; facilitated meetings for the discussion of Cancer Registries organized by IARC, WHO-PAHO and the UICC which occurred in Equador (2008), Brazil (2009), Cuba (2010 and Chile (2011), with broad participation of the representatives of various countries from the Region. The Latin America & the Caribbean Alliance for Cancer Control also fostered the establishment of a Latin America and Caribbean Tumor Biobank Network (www.uicc.org/advocacy/new-networkcancer-institutes-south-america-support-uicc-dvocacyefforts-un-summit-ncds).
It was pointed out, however, that in contrast to initiaves that result from International Congresses, the goal of producing regional cooperation requires commitment of individuals supplemented by some degree of institutionalization which formalizes the commitment of governments. In the care of Latin America, the Union of South American governments recognized the need for development and support of a Network of National Cancer Institutes (Red de Institutos Nacionales de Cáncer -RINC) (www2.rinc-unasur.org/wps/wcm/connect/ RINC/site/home/). The following strategic actions were identified as priorities for RINC: a) development and evaluation of cancer registries; b) training and capacity building; c) strengthening of national cancer institutes in the region; d) projects that address the national cancer priorities of RINC members.
Dr. Renee Otter, on behalf of the host of ICCC3 Dr Andrea Micheli shared perspectives on achievements and challenges following ICCC3 (Italy) stating the congress to be a successful initiative for the exchange of ideas, and for setting up collaborations and cooperation in global cancer control. The 3rd ICCC (ICCC3) also concentrated on the cooperation between Europe and Africa in cancer prevention, treatment, and control. The Cernobbio Declaration (www.tumori.net/it/brochures/ documenti/F_REPORT2.pdf ) to sustain cooperation on cancer control was presented at the ICCC3, and was signed by 200 congress participants from across the globe. Other results included significant attention generated in Italy to the issue of cancer control in Africa, which in turn has led to the initiation of an EU-AU network of bio-banks.
Dr. Otter expressed the importance of networking, sharing knowledge, and getting to know each other in small working groups, which are characteristic of ICCCs that needs to be preserved, Dr. Simon Sutcliffe also provided feedback on ICCC3. Most attendees have been influenced by the conference and felt that it has helped them in their cancer control work. Gaining knowledge on implementation of new innovations and networking were the primary reasons given for attending the congress.
Researchers and scientists comprised the largest group amongst all participants. There were also a large number of government officials, so the ICCC can perhaps have a greater influence on cancer control work by attracting larger numbers of policy makers. Most participants came to either increase awareness to current state-of-the-art clinical and scientific content of cancer control, or, were interested in how current state of knowledge is being implemented in various resource settings, or, to network.
The primary professional gain from the 3rd ICCC (ICCC3) for most participants was either new insights into cancer control strategies, or, improved understanding of population based cancer control programs globally, or new insights into cancer/NCD prevention. Participants appreciated the meeting content, ability to network, knowledge gain of work in areas of cancer control other than theirs, and ability to mingle in a global forum.
Mr. Massoud Samiei, the then leader of the Programme of Action for Cancer Therapy (PACT) (cancer.iaea. org/) since its inception, has been active in each of the ICCCs. The PACT Programme has sponsored auxiliary meetings, for countries who are either existing or potential Programme Model Demonstration Sites.
Mr. Samiei stated that ICCC is distinguished from other congress experiences by its 'evolving leadership'. He particularly thought ICCC2 Brazil was exceptional. The role of the leader, Dr Santini was very strong and it was further strengthened by the powerful government support he received. Another factor he thought that makes ICCC unique is the 'thematic approach' each congress takes. Lastly, the 'workshop approach' of the ICCCs reinforces its uniqueness. Participants and presenters engage in workshops to further explore the theme under discussion, one which is very relevant to the current scenario countries are experiencing. Participants enthusiastically participated in workshops where they assimilate ideas that they could apply in their jurisdictions, Mr. Samiei reported.
Dr. Eduardo Cazap, the then current president of the UICC at ICCC4, reported that ICCCs are different from other congresses in size (smaller), and not centered around treatment. Dr. Cazap expressed that participation by policy makers should be increased, but the detailed discussions were a particularly useful feature of the meetings.
Dr Andreas Ullrich, a World Health Organisation Medical Officer in Non-Communicable diseases, spoke of the ICCCs being an ideal forum for sharing of tools, models, approaches etc. The ICCCs enabled him to have ongoing contact with the WHO Regional Offices. Following the ICCC3, the WHO supported the creation of a political forum "Mediterranean Network" with the Ministry of Health Egypt as its chair. This forum is characterized by an intergovernmental working group that feeds into the development and planning of NCD/ cancer control programs in the Region. He stated that ICCC discussions contributed to knowledge translation in WHO member states.
Dr. Jin Soo Lee, President ICCC4 and the President of the National Cancer Center, Goyang, Republic of Korea, also felt that the consensus statements were important, and shared ICCC's interest in prevention and the need to close the gap between acute facilities and community by focusing on the need of the community.
Following the Panel Discussion, a live interactive session designed to evaluate the proceedings of the