Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low- and middle-income countries: systematic review
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.
KeywordsNeoplasms Surgery Radiotherapy Chemotherapy Palliative care Low- and middle-income countries
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.
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.
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