International Journal of Public Health

, Volume 63, Issue 9, pp 1047–1057 | Cite as

Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low- and middle-income countries: systematic review

  • Andrew DonkorEmail author
  • Tim Luckett
  • Sanchia Aranda
  • Jane Phillips



To appraise improvement strategies adopted by low- and middle-income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation.


A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL, and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system.


Of 3069 articles identified, 18 studied were included. These studies involved less than a tenth (n = 12, 8.6%) of all low- and middle-income countries. Most were case reports (58%), and the majority focused on palliative care (n = 11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure.


There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, vaccines, and technologies; financing; and leadership and governance.


Neoplasms Surgery Radiotherapy Chemotherapy Palliative care Low- and middle-income countries 


Authors’ contributions

All the authors contributed to the study design, manuscript development, editing, and completion of the manuscript. The article search and management were performed by AD. Article screening was completed by AD, and TL independently screened 10% of the articles. Quality assessment and study description were performed by AD. Coding of studies to the ICCC framework was performed by AD and TL. Data reduction was performed by AD and consensus discussions and finalising with JP, TL, and SA. Table design was completed by AD, JP, and TL.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article is based on a secondary analysis of the existing literature and does not contain any studies with human participants or animals performed by any of the authors. Good scientific standards have been followed according to the PRISMA statement.

Supplementary material

38_2018_1142_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 41 kb)


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Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Andrew Donkor
    • 1
    • 2
    Email author
  • Tim Luckett
    • 1
  • Sanchia Aranda
    • 1
    • 3
  • Jane Phillips
    • 1
  1. 1.Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation)University of Technology SydneySydneyAustralia
  2. 2.National Centre for RadiotherapyKorle-Bu Teaching HospitalAccraGhana
  3. 3.Cancer Council AustraliaSydneyAustralia

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