Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review

Martins, Tanimola; Merriel, Samuel W D; Hamilton, William

doi:10.1136/bmjopen-2020-038605

Cited by 12 publications

(18 citation statements)

References 44 publications

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“…However, all the studies provided valuable insights that we used in the narrative synthesis. A similar finding on data quality from this region has been highlighted before in a contemporary systematic on the routes to diagnosis of symptomatic cancer in SSA 79 Figure 3. illustrates the different domains and proportions of bias across the studies.…”

Section: Resultssupporting

confidence: 85%

“…A similar finding on data quality from this region has been highlighted before in a contemporary systematic on the routes to diagnosis Open access of symptomatic cancer in SSA. 79 Figure 3 illustrates the different domains and proportions of bias across the studies. For the studies that were assessed comprehensively all of them had an overall judgement of high or very high risk of bias.…”

Section: Assessment Of Study Qualitymentioning

confidence: 99%

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

Lombe

Mwamba

Msadabwe³

et al. 2023

BMJ Open

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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.

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Section: Resultssupporting

confidence: 85%

Section: Assessment Of Study Qualitymentioning

confidence: 99%

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

Lombe

Mwamba

Msadabwe³

et al. 2023

BMJ Open

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“…The pathway to cancer diagnosis is complex and influenced by a multiplicity of factors (Martins et al, 2020). For example, cancer screening relies heavily on self‐reported outcome measures (Tiro et al, 2005; Vernon, Meissner, et al, 2004); in most cases, obtaining information using these self‐reports can be quite challenging (Vernon, Briss, et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Behavioural oncology research in Africa: Lessons from the last two decades and key considerations moving forward

Ezenwankwo

Ogbodo

Alom

et al. 2021

European J Cancer Care

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Objective To analyse the state of behavioural oncology research in Africa and outline key considerations for future research. Methods Five bibliographic databases were searched to identify original English‐language articles published between January 2000 and August 2020. The Behavioural Epidemiology Framework was applied to studies with data/findings from Africa to delineate their current state. Research gaps/opportunities available for behavioural oncology research in Africa were further highlighted. Results Two hundred eighty‐seven original research with findings from Africa has been published over the last two decades, with the highest contribution arising from Nigeria, Kenya, Ethiopia and South Africa. Cervical and breast cancers were the most widely investigated. Prominently studied behaviours relate to cancer screening, health literacy, lifestyle, and vaccination. Behavioural oncology literature in Africa is generally in Phases I and III and lacks in measurement studies (<2%) and studies that seek to evaluate behaviour change/health promotion interventions (<6%) or translate them into practice (13.2%). Conclusion Embracing new and progressive approaches, including methodological/analytical paradigms and implementation science is imperative to advance the frontiers of behavioural oncology research in Africa. This calls for a responsive research approach that can mobilise multidisciplinary/multilevel coalitions, ensuring a research structure that effectively integrates behavioural research and cancer prevention/control in the region.

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“…There was no selection of patients by type of cancer. The interview tool, attached as Supplementary material , drew on medical and health systems literature on clinical and care pathways [ 16 , 17 ], but aimed particularly to contribute to the expanding exploratory qualitative literature on patients’ pathways to care in African contexts [ 18 – 21 ] especially patients’ experience including costs and other barriers to access [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

Makene

Ngilangwa

Santos

et al. 2022

BMC Health Serv Res

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Background This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. Methods Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. Results Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. Conclusions Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.

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Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review

Cited by 12 publications

References 44 publications

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

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

Behavioural oncology research in Africa: Lessons from the last two decades and key considerations moving forward

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

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