Barriers and challenges in providing standard breast cancer care in low resource settings

Abstract

In this study, we investigated the barriers to the delivery of internationally accepted breast cancer care in low resource settings (LRS) as compared to well-endowed resource settings (WRS) via an online survey. The survey was completed by 199 surgeons from eleven countries: 51 from WRS and 148 from LRS, based on our definition. The two most common facilities lacking in LRS were sentinel lymph node biopsy and immune-histochemistry (67% and 60% respectively). Only 22% respondents from LRS confirmed that all their eligible patients received hormonal therapy and only 8% radiotherapy as compared to 98% and 75% from WRS. Widespread limitations exist in most LRS, making internationally accepted breast cancer treatment guidelines impossible to follow, and thus resulting in suboptimal cancer care.

Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study

“…However, widespread limitations exist in most LMICs, making these guidelines impossible to follow, and thus resulting in suboptimal cancer care. 3 Core needle biopsy, SLNB and BCS are the three pillars of standard treatment for EBC. CNB is recommended, by most guidelines, as the technique of choice for obtaining tissue for histopathology.…”

“…a lack of trained surgeons, a lack of radiotherapy, a lack of frozen section facilities and low patient acceptance. 3,10,11 These are reasons for lower rates of BCS in LMICs (10–50%) as compared to rich countries (>60%). 12–14 Likewise, a direct relationship has been observed between the availability of radiotherapy and BCS rates, independent of demographic and tumour variables.…”

“…However, widespread limitations exist in most LMICs, making these guidelines impossible to follow, and thus resulting in suboptimal cancer care. 3…”

“…2 Most centres in LMICs struggle to provide basic standard care to breast cancer sufferers, thus leading to sub-optimal cancer care. 3 Hence, effective low-cost alternatives are needed to provide standard breast cancer care in LMICs.…”

Addressing Global Cancer Care Inequities Using Implementation Science and Community-Engaged Research Approaches

“…28 The widespread healthcare infrastructure limitations and lack of trained oncology workforce create barriers that impede the implementation and delivery of evidence-based cancer care treatment in resource-constrained settings, resulting in suboptimal care. 29 Any cancer care intervention that aims to reduce the overall burden of cancer in a population may inadvertently increase existing disparities if disadvantaged populations are excluded from the research studies demonstrating the intervention's effectiveness. 3 Therefore, inclusion of globally diverse populations in cancer clinical trials is imperative to develop cancer therapies that have the potential for broad reach to achieve more equitable clinical outcomes.…”