[Skip to Navigation]
Review
January 16, 2020

Barriers in Access to Care for Patients With Head and Neck Cancer in Resource-Limited Settings: A Systematic Review

Author Affiliations
  • 1Department of Surgery, McGill University, Montreal, Québec, Canada
  • 2PGY-4 Otolaryngology–Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada
  • 3Department of Medicine, McGill University, Montreal, Québec, Canada
  • 4Pediatric General and Thoracic Surgery, McGill University Health Centre, Montreal, Québec, Canada
  • 5Otolaryngology and Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
  • 6Otolaryngology and Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada
  • 7Department of Pediatric Surgery, McGill University Health Centre, Montreal, Québec, Canada
JAMA Otolaryngol Head Neck Surg. 2020;146(3):291-297. doi:10.1001/jamaoto.2019.4311
Key Points

Question  What are the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries?

Findings  In this mixed-methods systematic review of 18 studies that originated from Asia and Africa, a low level of literacy was statistically associated with a delayed presentation in 8 articles (44%), and lower socioeconomic status was statistically associated in 4 articles (22%). Qualitative articles identified misunderstanding of symptoms, use of alternative medicine, and inability to access health care as factors associated with a delayed presentation.

Meaning  Findings of this study may help identify the clinical and social validity of a given barrier to care in low-income and lower-middle-income countries and may guide future work in this understudied area.

Abstract

Importance  The identification of the barriers to care for patients with head and neck cancer in low-income and lower-middle-income countries is a crucial first step toward the identification of targets for developing and implementing cost-effective programs to increase awareness, prevention, and treatment of head and neck cancer in this setting.

Objective  To identify the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries.

Evidence Review  Nine databases were searched from their inception to December 21, 2017: Africa-Wide Information, the Cochrane Library, Embase, Global Health, LILACS, MEDLINE, BIOSIS Previews, and Web of Science. Search terms referred to head and neck cancer, barriers to care, and low- and lower-middle-income countries, and no temporal and linguistic restrictions were imposed. Articles were reviewed by 2 independent investigators, and differences in inclusion were resolved by discussion. Bibliographies of all included articles were screened, and all relevant articles were reviewed using the same procedure. Quantitative articles were assessed using the Methodological Index for Non-Randomized Studies tool, and articles with qualitative data used the Critical Appraisal Skills Programme qualitative checklist. This systematic review was registered in PROSPERO (registration No. CRD42018092448) and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.

Findings  Of the 44 articles selected for review, 18 (41%) met the selection criteria. All articles reported quantitative results, and 3 (17%) added some qualitative material to the study design. Most (11 [61%]) of the studies originated from India. A total of 41 different barriers to care were identified, with low level of education (cited in 8 articles [44%]), low socioeconomic status (in 4 articles [22%]), and lack of knowledge about head and neck cancer (in 3 articles [17%]) being statistically associated with a delayed presentation. Misunderstanding of signs and symptoms, use of alternative medicine, and inability to access health care were other barriers discussed in the qualitative articles.

Conclusions and Relevance  This systematic review highlighted the lack of both qualitative and quantitative information for patients with head and neck cancer in low-income and lower-middle-income countries. The findings suggest that integrating the barriers to care with information from patient lives may identify the clinical and social relevance of these barriers and guide future research.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×