Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery

Abstract

The global cervical cancer burden falls disproportionately upon women in low and middle-income countries. Insufficient infrastructure, lack of access to preventive HPV vaccines, screening, and treatment, as well as limited trained personnel and training opportunities, continue to impede efforts to reduce incidence and mortality in these nations. These hurdles have been substantial challenges to radiation delivery in particular, preventing treatment for a disease in which radiation is a cornerstone of curative therapy. In this review, we discuss the breadth of these barriers, while illustrating the need for adaptive approaches by proposing the use of brachytherapy alone in the absence of available external beam radiotherapy. Such modifications to current guidelines are essential to maximize radiation treatment for cervical cancer in limited resource settings.

Adjuvant carboplatin and paclitaxel after concurrent cisplatin and radiotherapy in patients with locally advanced cervical cancer

“…These are most likely to be available in developed countries only. Unfortunately, 85% of cases of cervical cancer occur in less-developed regions, where the disease is the second most common type of cancer and the third most common cause of cancer mortality 4. In the developing world, most patients with cervical cancer present with locally advanced disease, which is the main reason for higher mortality.…”

Perceptions and beliefs of lay people from northern Uganda regarding surgery for diagnosis and treatment of cervical cancer

“…Reasons for advanced stage cancer at diagnoses include health system barriers such as long distances to treatment facilities, health care professionals' misattribution or normalization of cancer symptoms, and patients' sociocultural beliefs related to stigma and fatalistic beliefs about cervical cancer, preference for indigenous medicines in treatment for cancer, and low self‐perceived risks of cancer thereby making patients attribute their cancer symptoms to other illnesses . In addition, there is low awareness about cancers and limited access to treatment modalities including surgery and radiotherapy in Uganda and most sub Saharan African countries . Previous bad experiences with and mistrust in health facilities potentially make the catchment communities delay help‐seeking .…”

“…5 In addition, there is low awareness about cancers and limited access to treatment modalities including surgery and radiotherapy in Uganda and most sub Saharan African countries. [8][9][10] Previous bad experiences with and mistrust in health facilities potentially make the catchment communities delay help-seeking. 11,12 Other factors that may make people not seek care in health facilities are fears related to a cancer diagnosis.…”

Single Radiotherapy Fraction with Local Anti-CD40 Therapy Generates Effective Abscopal Responses in Mouse Models of Cervical Cancer

“…Combined radiotherapy regimens offer maximal local control of cancerous lesions, while sparing the healthy tissues and extending the survival of patients [1,7]. However, for most women in LMIC and other resource-poor settings who are disproportionately affected and diagnosed at an advanced stage, socio-economic barriers influence patient compliance with many fractions of radiotherapy and/or chemotherapy [8,9]. More accessible therapeutic approaches are needed for many patients with advanced disease.…”