Model of delivery of cancer care in South Africa’s Eastern Cape and Mpumalanga provinces: a situational analysis protocol

Abstract

IntroductionCancer contributes to a significant proportion of morbidity and mortality globally. Low-income and middle-income countries such as South Africa tend to be characterised by poor and inequitable access to cancer services. Cancer resources are more likely to be found in urban areas, tertiary centres and quaternary hospitals. However, little is known about the linkages to care, continuity of care and packages of cancer care in rural South African settings. This study describes cancer service delivery for South Africa’s Eastern Cape and Mpumalanga provinces.Methods and analysisA mixed-methods qualitative and quantitative research methods of three substudies which include semistructured interviews with patients, focus group discussions with health providers and a quantitative record review that will be carried out at both Rob Ferreira hospital, Witbank hospital and Nelson Mandela Academic hospital in Mpumalanga and Eastern Cape province, respectively. Instruments assess demographic characteristics, explore packages of cancer care, explore challenges experienced by health professionals, and maps out the referral pathway of patients with a cancer diagnosis in the study sites. Numerical, quantitative data will be explored for normality using the Shapiro-Wilk test and reported using either the mean, SD and range or the median and IQR depending on the normality of the distribution. Qualitative data will be analysed using the phenomenological approach.Ethics and disseminationEthics approval was obtained from the Human Research Ethics Committee of Walter Sisulu University (040/2020) and the University of the Witwatersrand (M210211), South Africa. To the research team’s knowledge, this is the first study presenting the model of cancer delivery in South Africa’s Eastern Cape and Mpumalanga province. This will thus provide better understanding of cancer service delivery systems, packages of cancer care from primary care to quaternary care.

Funding of Oncology Benefits by Medical Schemes, South Africa: A Focus on Breast and Cervical Cancer

“…This study finds a higher number of beneficiaries diagnosed with breast cancer, nearly ten times more than those diagnosed with cervix cancer. These findings are consistent with the literature, where breast cancer is the most common cancer in women [20][21][22]27]. The study also found that 97% of breast cancer was diagnosed in females than in males, who accounted for 3 % of breast cancer, slightly higher than another study conducted in the public sector the study found the rate of 1.4% [33].…”

“…Breast cancer is the most common cancer among women and the top cause of death in more than 100 countries worldwide [20][21][22]. Over two million new breast cancer cases have been detected worldwide, representing a quarter of all cancer cases in women [20,23,24].…”

“…Over two million new breast cancer cases have been detected worldwide, representing a quarter of all cancer cases in women [20,23,24]. The incidence of breast cancer in the WHO'sAfrican region (AFRO) accounts for 27.7 percent of all cancer cases, and there are 29,593 breast cancer patients in South Africa [20,22,25]. The high incidence rates in affluent and developing nations are driven by non-genetic risk factors associated with menstruation, reproduction, exogenous hormone replacement, alcohol consumption, and weight gain [20,[26][27][28].…”

“…In 2020, cervical cancer was the fourth most prevalent cancer in women worldwide, with a projected incidence of more than 600,000 cases and over 350,000 deaths [21,22]. Cervical cancer incidence and mortality rates are the greatest in Africa, notably in Southern, Eastern, and Western Africa [25].…”

“…Cervical cancer incidence and mortality rates are the greatest in Africa, notably in Southern, Eastern, and Western Africa [25]. Cervical cancer is the most common in many Sub-Saharan African countries (22 percent of all cancers), and its prevalence in poor developing countriesispotentially15timeshigher.After breast cancer, cervical cancer accounts for 18.7 percent of all cancer incidences in South Africa's female population [22,27]. The incidence of cervical cancer increases with age, with the average age of diagnosis ranging from 35 to 44.…”