Delays and Barriers to Cancer Care in Low- and Middle-Income Countries: A Systematic Review

Brand, Nathan; Qu, Liang G.; Chao, Ann; Ilbawi, André

doi:10.1634/theoncologist.2019-0057

Cited by 139 publications

(142 citation statements)

References 16 publications

(19 reference statements)

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“…Similar, a study performed in Malaysia revealed a median time interval of 5.5 months for the time between the first medical visit and diagnosis [30]. The present value of 56.0 days was within the median time span ranging from 0.9 to 5.0 months for the time interval between the first medical visit and the completed diagnosis of nine studies from low-and middle-income countries [31].…”

Section: Time Intervals and Delays In Tti Of All Patientssupporting

confidence: 86%

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Andrade

Santos

Oliveira

et al. 2020

Preprint

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Background: The diagnosis of breast cancer, from first medical visit until treatment initiation, requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals among patient groups. Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p= 0.033) and 4.44-fold (95%CI: 1.58-12.46; p= 0.004), respectively. The median time between the first medical visit and the diagnostic result and between the first medical visit and the initiation of treatment was, respectively, 56.0 and 116.5 days. For these time intervals, 54 (34.8%) and 114 (64.8%) patients had a delay of >90 days for diagnostic results and the initiation of treatment, respectively. For patients in the FAP and HNL who had a delay of >90 days, the median time between the first medical visit and the diagnostic results was 180 and 158 days, respectively (p= 0.032). If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median delay between diagnostic mammography and the diagnostic result was 65.0 or 29.0 days, respectively, compared to 53.0 days in the integrated (HNL) publicly financed system (p < 0.050). The median time between the first medical visit and the diagnostic results of all patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p < 0.050).Conclusions: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.

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Section: Time Intervals and Delays In Tti Of All Patientssupporting

confidence: 86%

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Andrade

Santos

Oliveira

et al. 2020

Preprint

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“…Delay to cancer diagnosis can occur in any or all of three stages; presentation to the doctor (also called the patient interval), diagnosis, or access to treatment [ 13 ]. While diagnosis and treatment intervals were found to be comparable in low- and middle-income countries (LMICs) with those in high-income countries, the patient interval was found to be longer in LMICs [ 14 , 15 ]. A prolonged patient interval is a significant contributor to worse patient outcomes and a factor for 70% of global cancer mortality occurring in LMICs [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study

Elshami

Böttcher

Alkhatib

et al. 2021

BMC Health Serv Res

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Background Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors. Methods A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15–17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females. Results Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report ‘feeling scared’ as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report ‘embarrassment’, ‘worry about wasting doctor’s time’ and ‘difficulty arranging transport’. This was also seen for recalling risk factors, where ‘embarrassment’ and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting ‘embarrassment’ and ‘feeling scared’. Conclusions The most commonly perceived barriers to seeking cancer care were ‘feeling scared’ and ‘feeling worried about what the doctor might find’, followed by practical and service barriers. Females and adolescents were more likely to report ‘fear’ as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.

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“… 1 6 While the incidence of cancers increases in LMICs, many cases continue to go undiagnosed because of a lack of high-quality population-based registries, and when diagnosed, the majority present at late-stage with consequently poor outcomes. 7–9 …”

Section: Introductionmentioning

confidence: 99%

“…Breast and cervical cancer mortality and survival are largely influenced by the timeliness of diagnosis and effectiveness of treatment modalities. 7 8 10 In many LMICs, breast and cervical screening and early diagnosis programmes do exist in some form, however, they tend to be opportunistic and not well organised. 11–13 There is often poor access to high quality, affordable breast and cervical cancer treatment, particularly where the health systems are fragile or fragmented.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries: a systematic review protocol

Nnaji¹,

Kuodi

Walter

et al. 2020

BMJ Open

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IntroductionBreast and cervical cancers pose a major public health burden globally, with disproportionately high incidence, morbidity and mortality in low- and middle-income countries (LMICs). The majority of women diagnosed with cancer in LMICs present with late-stage disease, the treatment of which is often costlier and less effective. While interventions to improve the timely diagnosis of these cancers are increasingly being implemented in LMICs, there is uncertainty about their role and effectiveness. The aim of this review is to systematically synthesise available evidence on the nature and effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in LMICs.Methods and analysisA comprehensive search of published and relevant grey literature will be conducted. The following electronic databases will be searched: MEDLINE (via PubMed), Cochrane Library, Scopus, CINAHL, Web of Science and the International Clinical Trials Registry Platform (ICTRP). Evidence will be synthesised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Two reviewers will independently screen the search outputs, select studies using predefined inclusion criteria and assess each included study for risk of bias. If sufficient data are available and studies are comparable in terms of interventions and outcomes, a meta-analysis will be conducted. Where studies are not comparable and a meta-analysis is not appropriate, a narrative synthesis of findings will be reported.Ethics and disseminationAs this will be a systematic review of publicly available data, with no primary data collection, it will not require ethical approval. Findings will be disseminated widely through a peer-reviewed publication and forums such as conferences, workshops and community engagement sessions. This review will provide a user-friendly evidence summary for informing further efforts at developing and implementing interventions for addressing delays in breast and cervical cancer diagnosis in LMICs.PROSPERO registration numberCRD42020177232.

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Delays and Barriers to Cancer Care in Low- and Middle-Income Countries: A Systematic Review

Cited by 139 publications

References 16 publications

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study

Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries: a systematic review protocol

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