Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

Abstract

ObjectivesLate presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA.DesignSystematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool.Data sourcesPubMed and Embase, for publications from January 1995 to March 2021.Eligibility criteriaInclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. Exclusion criteria: paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways).Data extraction and synthesisTwo reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes.Results57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines.ConclusionsRobust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.

Barriers to optimal management of cancer pain in sub-Saharan Africa: a scoping review

“…Hence, only those who can afford to pay for the cost for healthcare services could have access to pain medications [ 30 ]. This finding is also corroborated by another review where cost was highlighted as the major contributory factor to delays in cancer care pathway in sub-Saharan Africa [ 38 ].…”

Cross-Cultural Adaptation and Psychometric Properties of the Swahili Version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 among Breast Cancer Patients in Tanzania

“…The global quality of life score of the EORCT QLQ-BR45 and QLQ C-30 Swahili version among breast cancer patients in Tanzania was low, being 63 (SD = 20). This could probably be due to a late diagnosis [ 45 ] and low socio-economic status [ 12 ]. Moreover, continuity of care among cancer patients in Tanzania after discharge from the cancer care centre is a big challenge, as most of the patients rely upon primary healthcare facilities with non-oncology specialities [ 10 , 11 , 25 ].…”

Defining national research priorities for prostate cancer in Zambia: using the Delphi process for comprehensive cancer policy setting in sub-Saharan Africa

“…22 key themes were identified from the two systematic reviews as being significant potential barriers to seeking, reaching and receiving high-quality cancer care (box 1). 4 In order to determine the research themes that should be prioritised for further evaluation in the Zambian context and specifically for prostate cancer, each barrier was assigned a total score (out of 20). This was summed up from each of the four criteria which could be assigned a value 1-5 namely (a) feasibility (how easy it would be to research this thematic area empirically; (b) large scale (the proportion of prostate cancer sufferers); (c) high Impact (significance in cause of death or disability for prostate cancer patients); (d) modifiable (the barrier identified can be addressed to improve care for men with prostate cancer).…”

“…[1][2][3] However, cancers affecting men have not received much attention. 4 Prostate cancer is emerging as a major health threat in SSA with patients typically presenting with late-stage incurable disease. 5 The age standardised incidence rate in 2020 was 69.2 per 100 000 men.…”