145 Background: The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 27 leading cancer centers in the United States (US), but the NCCN’s mission to improve cancer care extends world-wide. Nearly half of the registered users of the NCCN Guidelines are based outside the US, and the NCCN has developed a process for adapting its Guidelines to lower-resourced settings. The cancer burden in Sub-Saharan Africa (SSA) is significant – by 2030, annual cancer deaths in the region are projected to reach 1,000,000 people – and most cancers diagnosed in SSA are late-stage. Methods: The NCCN Framework outlines a rational approach for constructing cancer management systems to provide the highest achievable care. Each of the 4 NCCN Framework levels builds on the one before it, so care can evolve as resources grow: “Basic Resources” are essential for care; “Core Resources” add services improving disease outcomes; and “Enhanced Resources” include more cost-prohibitive services. The Guidelines themselves are the final level: evidence-based, consensus-driven recommendations from each NCCN Panel. Resource-stratification begins with modification of the Guidelines by a NCCN Framework Committee within each Panel. Results: In the case of SSA, organizers from the NCCN, American Cancer Society, Clinton Health Access Initiative, and IBM arranged 3 consensus meetings in which resource-stratified drafts of the Guidelines for Palliative Care and Cancer Pain will be refined by a committee of NCCN representatives, oncologists, and palliative care providers from Burundi, Ethiopia, Ghana, Kenya, Nigeria, Uganda, and the US. Important themes emerging from the first meeting included early screening for palliative care needs, even before tissue diagnosis, in areas with limited availability of anti-cancer therapy. In addition, cultural differences on the topic of “Physician-Aid-in-Dying” led to its replacement with guidance on caring for patients expressing a wish to die. Conclusions: Collaboration with colleagues in SSA, and other areas around the globe, to resource-stratify NCCN Guidelines will allow more systematic use of the guidelines and improve the quality, effectiveness, and efficiency of cancer care.