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

OBJECTIVES: Late 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. DESIGN: Systematic revie...

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Autores principales: Lombe, Dorothy Chilambe, Mwamba, Monde, Msadabwe, Susan, Bond, Virginia, Simwinga, Musonda, Ssemata, Andrew Sentoogo, Muhumuza, Richard, Seeley, Janet, Mwaka, Amos Deogratius, Aggarwal, Ajay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106057/
https://www.ncbi.nlm.nih.gov/pubmed/37055211
http://dx.doi.org/10.1136/bmjopen-2022-067715
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author Lombe, Dorothy Chilambe
Mwamba, Monde
Msadabwe, Susan
Bond, Virginia
Simwinga, Musonda
Ssemata, Andrew Sentoogo
Muhumuza, Richard
Seeley, Janet
Mwaka, Amos Deogratius
Aggarwal, Ajay
author_facet Lombe, Dorothy Chilambe
Mwamba, Monde
Msadabwe, Susan
Bond, Virginia
Simwinga, Musonda
Ssemata, Andrew Sentoogo
Muhumuza, Richard
Seeley, Janet
Mwaka, Amos Deogratius
Aggarwal, Ajay
author_sort Lombe, Dorothy Chilambe
collection PubMed
description OBJECTIVES: Late 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. DESIGN: Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES: PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA: Inclusion 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 SYNTHESIS: Two 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. RESULTS: 57 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. CONCLUSIONS: Robust 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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spelling pubmed-101060572023-04-17 Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review Lombe, Dorothy Chilambe Mwamba, Monde Msadabwe, Susan Bond, Virginia Simwinga, Musonda Ssemata, Andrew Sentoogo Muhumuza, Richard Seeley, Janet Mwaka, Amos Deogratius Aggarwal, Ajay BMJ Open Health Policy OBJECTIVES: Late 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. DESIGN: Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES: PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA: Inclusion 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 SYNTHESIS: Two 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. RESULTS: 57 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. CONCLUSIONS: Robust 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. BMJ Publishing Group 2023-04-13 /pmc/articles/PMC10106057/ /pubmed/37055211 http://dx.doi.org/10.1136/bmjopen-2022-067715 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Health Policy
Lombe, Dorothy Chilambe
Mwamba, Monde
Msadabwe, Susan
Bond, Virginia
Simwinga, Musonda
Ssemata, Andrew Sentoogo
Muhumuza, Richard
Seeley, Janet
Mwaka, Amos Deogratius
Aggarwal, Ajay
Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title_full Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title_fullStr Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title_full_unstemmed Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title_short Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review
title_sort delays in seeking, reaching and access to quality cancer care in sub-saharan africa: a systematic review
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106057/
https://www.ncbi.nlm.nih.gov/pubmed/37055211
http://dx.doi.org/10.1136/bmjopen-2022-067715
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