Treatable cancers are on the rise due to improved early diagnosis and more innovative treatments, and preventative strategies against cancer are becoming a global concern. With the rapidly increasing complexity of cancer treatment, a clear definition of what constitutes ethical cancer care has become a matter of great debate. This situation is more complex in a developing country where healthcare resources are limited. Doctors, nurses and public health professionals engaged in the prevention, screening, diagnosis, treatment and research of cancers are often posed with ethical dilemmas while making complex choices. With a special focus on low- and middle-income countries, this paper is intended to highlight these real-world ethical concerns facing those involved in the management of cancer patients. While taking a neutral view, this paper has adopted a theme-wise approach to discuss barriers in cancer care.
Background: Much of the global cancer burden is in low-and middle-income countries (LMICs). Along with the high incidence of cancer, most LMICs have unevenly distributed health care resources. This study is a qualitative exploration of the journey of patients accessing cancer care in India and their caregivers. Methods:The study followed a cross-sectional qualitative design. Participants were recruited by stratified purposive sampling, and all common cancers in India as reported by the GLOBOCAN database were included in the study. Consenting patients and their caregivers were interviewed using in-depth interview techniques. The data was analysed using principles of qualitative content analysis.Results: Cancer patients (n = 100) and their caregivers (n = 48) were interviewed for the study. The six themes that emerged were related to a) the journey of patients to access care, b) the psychological journey of patients, c) stigma of cancer patients, d) decisionmaking and adherence to treatment, e) economic costs of cancer care and its impact and f) modifiers to accessing cancer care. Conclusions:Planning and policymaking in the future of cancer care delivery need to consider the views expressed by the cancer patients and their caregivers as regards to access, adherence and disruptions to cancer care in India. Future policies will hopefully address some of the difficulties faced by patients.
Tobacco is one of the biggest global health concerns of this century with a significant contribution to the increasing burden of cancers, chronic diseases and associated mortality. Tobacco-related cancers are one of the commonest causes of cancer-related mortality in low- and middle-income countries (LMICs). The tobacco epidemic is constantly on the rise, affecting LMICs in particular due to a lack of awareness in the population, insufficient health infrastructure and weak regulatory interventions. India is home to the world’s largest youth population and a large percentage of them take up tobacco at a very young age, leading to subsequent habit formation. There is limited evidence in published research from India on young people’s perceptions on the use and control of tobacco. This qualitative study has attempted to bridge that knowledge gap; a thematic analysis was used on the qualitative data gathered from young university students who participated in interviews and focus group discussions, which was then compared and contrasted with a critical analysis of India’s national tobacco control measures. It employed a health policy analysis framework to understand how gaps in the national tobacco control initiatives contribute towards tobacco use in young people and what opportunities for policy reform exist. The main results revealed social and behavioural factors, peer dynamics and lack of awareness to be majorly influencing the tobacco debut and use in youth. Some other important findings emerged such as a lack of available support for tobacco cessation, leading to failure in quitting, a lack of understanding about the ill effects of tobacco and an overall lack of belief in the existing tobacco control measures. The qualitative results were further triangulated by the critical analysis of the national tobacco control policies, comparing them with the WHO Framework Convention on Tobacco Control. Juxtaposition of the qualitative research findings with the policy analysis reveals possible gaps in implementation of the tobacco laws. The findings from this study will inform health policymakers, public health professionals, clinicians, the government and other voluntary organisations to strengthen national tobacco control efforts.
Background: Addressing the mental health needs of cancer patients and their caregivers improves the quality of care the patient receives in any cancer care ecosystem. International practice currently encourages integrated care for physical and mental health in oncology. The coronavirus disease (COVID-19) pandemic has affected the delivery of healthcare services across the world. The current research paper is on the psycho-oncology service provision for hospitalised cancer patients before and during the COVID-19 pandemic.Methods: All patients who were referred to psycho-oncology services during the study period of 1 month, in the two successive years of 2019 and 2020, were included in the study. Retrospective data were collected from the centralised electronic medical records for patients. Data included cancer diagnosis, reason for admission, admitting team and reason for a psychiatric referral. Other parameters that were measured were the timing of the psychiatric assessment, psychiatric diagnosis and psycho-oncology care provided, which included psychological interventions carried out and medications prescribed. The overall institutional data on cancer care provision are also presented in brief to provide context to the psycho-oncology services.Results: Integrated psycho-oncology services reviewed and managed patients round the year in the hospital where the study was conducted. During the 1-month study period, in 2019 and 2020, the total number of hospitalised cancer patients managed by the services was 74 and 52, respectively. During the study period of 2020, 292 patients with cancer who were being treated in the hospital had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested on reverse transcription-polymerase chain reaction (RT-PCR) and 50 members of healthcare staff also tested positive. The most Research
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