Nepal is a small, low-income country between India and China with a unique health care delivery system. Cancer is becoming an important public health problem in the country, but a systematic plan to cancer control is lacking. In this article, we aim to provide a systematic assessment of the burden of disease and available resources and suggest prioritization approaches for the future to assist with any such future cancer control plans for the country.

Thecoronavirusdisease2019(COVID-19)pandemichas brought critical challenges to the practice of oncology in many high-income countries (HICs) such as the US and Canada. Measures are now being taken to reduce the flow of patients to cancer centers and hospitals by substituting electronic or telehealth visits for in-person visits wherever feasible, reducing the frequency of follow-up visits, reducing surveillance imaging and other tests, and engaging in discussions about which are the most important anticancer therapies to deliver, if and when capacity to provide treatments become reduced. These are just a few of the measures being taken by health care institutions and physicians to minimize face-to-face patient visits to control the spread of COVID-19 and to optimally deploy health care workers in the health system. These are obviously rational stepstotakeduringapandemic,especiallyasnewdatasuggests that patients with cancer may be at a higher risk of death with COVID-19 infections, although there are some uncertainties about the reliability of this information. 1 Could this new wave of awareness to identify and discourage unnecessary in-person visits, testing, and lowvalue treatments provide a lasting benefit to our cancer systems beyond the pandemic period? The necessity to change, adapt, and innovate created by the COVID-19 pandemic may yield a more lasting series of changes that can help address overstretched, costly, and at times inefficient cancer care systems. It is evident that, going forward in the post-COVID-19 world, there will be severe economic residua of the lockdowns and restrictions imposed to curb the pandemic, and saving precious health care resourcesandfundingwillbeapriority.Thus,decisionsmade duringthisperiodwillbeanopportunitytoidentifyanddiscourage low-value practices in oncology. 2 Theconceptof"value-basedcancercare"hasgarnered a great deal of attention in recent years. Although in some jurisdictions, the oncology community and regulatory authorities have favored access to and approval of new cancer drugs based on intermediate end points, others have arguedthatthereshouldbeclearevidenceofimprovement insurvivalorqualityoflife,particularlywhenmostsuchnew therapeutics come at substantial cost. At this time of pandemic, however, we are seeing a coming together of many intheoncologycommunitytoreevaluatetheprioritytherapiestobeofferedtopatients:focusingonthosethatclearly improve outcomes in a meaningful way that justify the increased risks to patients of coming to hospitals to receive treatment. 3 It will also be important to observe if patient decision-making is affected: the minimal absolute gains of some standard therapies (eg, some adjuvant situations where recurrence risk is relatively low; third-or fourth-line metastatic disease treatments), may be weighed by patientsnegativelygiventherisktheyperceivetotheirhealth in attending clinics during the pandemic.

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