Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study

Alwash, Zainab; Henke, Oliver; Serventi, Furaha; Kantelhardt, Eva Johanna

doi:10.1200/jgo.18.00246

Cited by 11 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The country has a population of over 60 million people but fewer than 20 oncologists and only four cancer treatment centers ‐ Aga Khan Hospital in Dar-es-salaam, Bugando Medical Centre, Kilimanjaro Christian Medical Centre, and the Ocean Road Cancer Institute. This is insufficient for a disease that is one of the leading non-communicable diseases in the country, accounting for 7.6% of deaths [ 35 ]. As the country seeks to scale its cancer treatment more broadly, it must dedicate more resources to social services and reduce the emotional burden of care for patients, which has a profound impact on treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“Let him die. He caused it”: A qualitative study on cancer stigma in Tanzania

Mwobobia,

Knettel,

Headley

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

Cancer stigma presents a critical barrier to care seeking, contributing to delayed presentation and poor cancer outcomes worldwide. The burden of cancer in Tanzania is on the rise, with cancer being the third-leading cause of death in the country. Despite rising incidence and poor outcomes of cancer, cancer-related stigma interventions have received low prioritization. There is a need for sound research that focuses on understanding attitudes driving stigma, its impact on care-seeking and treatment adherence, and intervention models to reduce stigma. We used a cross-sectional qualitative study design. We administered three open-ended qualitative questions to 140 adults newly diagnosed with cancer in Moshi, Tanzania. The questions explored common attitudes toward people with cancer, the perceived impact of cancer-related stigma on care engagement, and ideas for reducing cancer stigma. Patients were recruited during routine appointments at the Cancer Center at Kilimanjaro Christian Medical Center. Data were analyzed using a team-based, applied thematic approach and NVivo 12 software. All participants described stigma as a significant challenge for treatment and receiving support from their social networks. Perceptions of financial burden, misconceptions about cancer, such as the belief that it is contagious, and fear of death, were common attitudes driving cancer stigma. Most participants feared that symptoms would prevent them from being able to work and that the cost of cancer care would drive away loved ones. Stigma was not a ubiquitous response, as some participants reported increased care and social support from family members after a cancer diagnosis. Experiences of stigma contributed to feelings of shame, fear of burdening the family, reduced resources to access treatment, and disengagement from care. Common substitutes to medical therapies included religious interventions and traditional medicine, perceived as less expensive and less stigmatizing. Many participants felt they would benefit from improved financial support, professional counseling, and education for families and communities to reduce stigmatizing attitudes and enhance social support. There is a need for intervention studies focused on improving cancer literacy, community advocacy to reduce cancer stigma, and increasing emotional and practical support for people with cancer and their families. There is also a clear need for policy efforts to make cancer care more affordable and accessible to reduce the financial burden on patients and families.

show abstract

Section: Discussionmentioning

confidence: 99%

“Let him die. He caused it”: A qualitative study on cancer stigma in Tanzania

Mwobobia,

Knettel,

Headley

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…This perspective supported our hypothesis that successful guideline implementation will require addressing a variety of both internal and external factors. A qualitative study of staff perspectives at the newly established cancer center at Kilimanjaro Christian Medical Centre in Moshi, Tanzania revealed some common challenges, such as resource and infrastructure limitations, medication shortages, understaffing relative to high volumes of patients, and the need for oncology nursing training [ 27 ]. Challenges in technology have also been reported in other studies in sub‐Saharan African countries [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania

et al. 2021

View full text Add to dashboard Cite

Background. In response to the increasing burden of cancer in Tanzania, the Ministry of Health Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory-informed implementation strategy to promote guideline-concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline-based practice prior to launching of TNCTG. Methods. In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis. Results. Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included: capacity and infrastructure, information technology, communication, efficiency and quality of services provided. Contextual factors external to ORCI included: inter-institutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania. Conclusion.Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in effort to improve uptake of the TNCTGs at ORCI. Implications for practice. This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline-concordant cancer care in Tanzania and comparable settings. The Oncologist ;9999:• •

show abstract

“…15 In recent years, there have been developments in the health care infrastructure in our area since oncologic services were established in December 2016. 16 This has helped create awareness of cancer in the community, enabling them to access the available services. 16 Although the coverage is still low, the explanation is plausible, but probably only partly, for clarifying the observed increase in the reporting of CRC cases.…”

Section: Discussionmentioning

confidence: 99%

“…16 This has helped create awareness of cancer in the community, enabling them to access the available services. 16 Although the coverage is still low, the explanation is plausible, but probably only partly, for clarifying the observed increase in the reporting of CRC cases.…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges

Herman

Hawkins

Misso

et al. 2020

JCO Global Oncology

Self Cite

View full text Add to dashboard Cite

PURPOSE A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.

show abstract

Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study

Cited by 11 publications

References 17 publications

“Let him die. He caused it”: A qualitative study on cancer stigma in Tanzania

“Let him die. He caused it”: A qualitative study on cancer stigma in Tanzania

Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges

Contact Info

Product

Resources

About