What are the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries?
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.
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.
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.
To identify the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries.
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.
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.
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Beaudoin P, Anchouche S, Gaffar R, Guadagno E, Ayad T, Poenaru D. Barriers in Access to Care for Patients With Head and Neck Cancer in Resource-Limited Settings: A Systematic Review. JAMA Otolaryngol Head Neck Surg. 2020;146(3):291–297. doi:10.1001/jamaoto.2019.4311
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