Background Lung cancer is the highest incident cancer globally and is associated with significant morbidity and mortality particularly if identified at a late stage. Poor patient outcomes in low- and middle-income countries (LMIC’s) might reflect contextual patient and health system constraints at multiple levels, that act as barriers to prevention, disease recognition, diagnosis, and treatment. Lung cancer screening, even for high-risk patients, is not available in the public health sector in South Africa (SA), where the current HIV and tuberculosis (TB) epidemics often take precedence. Yet, there has been no formal assessment of the individual and health-system related barriers that may delay patients with lung cancer from seeking and accessing help within the public health care system and receiving the appropriate and effective diagnosis and treatment. This study aimed to derive consensus from health-system stakeholders in the urban Gauteng Province of SA on the most important challenges faced by the health services and patients in achieving optimum lung cancer management and to identify potential solutions. Methods The study was undertaken among 27 participant stakeholders representing clinical managers, clinicians, opinion leaders from the public health sector and non-governmental organisation (NGO) representatives. The study compromised two components: consensus and engagement. For the consensus component, the Delphi Technique was employed with open-ended questions and item ranking from five rounds of consensus-seeking, to achieve collective agreement on the most important challenges faced by patients and the health services in achieving optimal lung cancer management. For the engagement component, the Nominal Group Technique was used to articulate ideas and reach an agreement on the group’s recommendations for solution strategies and approaches. Results Public health sector stakeholders suggested that a lack of knowledge and awareness of lung cancer, and the apparent stigma associated with the disease and its risk factors, as well as symptoms and signs, are critical to treatment delay. Furthermore, delays in up-referral of patients with suspected lung cancer from district health care level were attributed to inadequate knowledge arising from a lack of in-service training of nurses and doctors regarding oncologic symptoms, risk factors, need for further investigation, interpretation of x-rays and available treatments. At a tertiary level, participants suggested that insufficient availability of specialised diagnostic resources (imaging, cytological and pathological services including biomolecular assessment of lung cancer), theatres, cardiothoracic surgeons, and appropriate therapeutic modalities (chemotherapeutic agents and radiation oncology) are the main barriers to the provision of optimal care. It was suggested that a primary prevention programme initiated by the government that involves private-public partnerships may improve lung cancer management nationally. Conclusions Considerable barriers to the early identification and treatment of lung cancer exist. Finding solutions to overcome both individual and health-system level obstacles to lung cancer screening and management are vital to facilitate early identification and treatment, and to improve survival. Furthermore, research on inexpensive biomarkers for asymptomatic disease detection, the introduction of diagnostic imaging tools that utilise artificial intelligence to compensate for inadequate human resources and improving clinical integration across all levels of the healthcare system are essential.
PURPOSE The purpose of the study was to explore the key stakeholders’—health care professionals, patients, and family caregivers—experiences of providing, receiving, and setting priorities for lung cancer care in KwaZulu-Natal, South Africa, with a view to propose potentially effective interventions for improved care. METHODS This was a qualitative study conducted in 5 communities and 3 hospitals offering oncology services in KwaZulu-Natal Province. Data were generated using in-depth interviews and the nominal group technique. Nineteen patients with lung cancer, 20 family caregivers (FCs) and 18 health care professionals (HCPs) were interviewed, with an additional subsample of 7 HCPs participating in the nominal group technique. Results were analyzed using thematic analysis. RESULTS Similar to patients with lung cancer and FCs, HCPs were concerned about the limited access to oncology services and poor lung cancer diagnostic facilities, as these also ranked high in HCPs’ priority settings. Limited access was attributed to a lack of lung cancer awareness and low lung cancer suspicion index among different stakeholders, a shortage of health care specialists, poor diagnostic equipment and general resource constraints, unavailability of diagnostic services at the lowest levels of health care (for example, primary health care), geographic location of specialized services, and poor multidisciplinary collaboration. Patients’ perceptions of the quality of care in public health facilities also affected their treatment-seeking behavior. Challenges experienced at the health care worker-patient level also affected the FCs. For example, FCs were psychosocially and economically affected by the caring responsibilities, which, in turn, was an important determinant of a patient’s care pathways. CONCLUSION As a result of this study, new approaches to lung cancer care are being explored, including increased community awareness, the introduction of well-equipped community mobile screening services, patient navigation to track patients, and building cadres for providing and integrating palliative care services into the mainstream health systems.
Background: The coordination of cancer care among multiple providers is vital to improve care quality and ensure desirable health outcomes across the cancer continuum, yet evidence is scarce of this being optimally achieved in low- and middle-income countries (LMICs). Objective: Through this scoping review, our objective was to understand the scope of cancer care coordination interventions and services employed in LMICs, in order to synthesise the existing evidence and identify key models and their elements used to manage and/or improve cancer care coordination in these settings. Methods: A detailed search strategy was conducted, aligned with the framework of Arksey and O’Malley. Articles were examined for evidence of coordination interventions used in cancer care in LMICs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension Guidelines for Scoping Reviews, which included a checklist and explanation. The PRISMA flow diagram was utilised to report the screening of results. Data were extracted, categorised and coded to allow for a thematic analysis of the results. Results: Fourteen studies reported on coordination interventions in cancer care in LMICs. All studies reported a positive impact of cancer coordination interventions on the primary outcome measured. Most studies reported on a patient navigation model at different points along the cancer care continuum. Conclusions: An evidence-based and culturally sensitive plan of care that aims to promote coordinated and efficient multidisciplinary care for patients with suspicion or diagnosis of cancer in LMICs is feasible and might improve the quality of care and efficiency.
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