Barriers in Access to Care for Head and Neck Cancer Patients in Sub-Saharan Africa
[Thesis]
Beaudoin, Pier-Luc
Ayad, Tareck
McGill University (Canada)
2020
88
M.Sc.
McGill University (Canada)
2020
Background Head and neck cancer is the 7th most common cancer worldwide, with the majority of new cases arising in low- and middle- income countries. Patients from low- and middle- income countries often present with advanced disease and require extensive surgical and multimodal treatment. Although the burden in Sub-Saharan Africa is well documented, no evidence-based strategies exist to identify the barriers in access to care and facilitate early detection. Objective Create an evidence-based approach using a theoretical framework to adequately identify barriers in access to care for patients in sub-Saharan Africa. Methods Patients with a diagnosis of head and neck cancer were selected from two independent university hospitals in Senegal to participate in a mixed-methods descriptive study. Data related to barriers to care were collected using tools developed based on our systematic review of the literature. A focused ethnographic qualitative approach was used to identify factors that delay presentation, referral, and treatment. Data was analyzed using a deductive approach based on our published theoretical framework. Results Thirty-three patients with a mean age of 57.8 years were included. Presentation delay was 5.7 months, mainly attributed to cost of consultation (39%), waiting time at the doctor's office (15%), and distance to healthcare facility (12%). Referral delay greater than 3 months was observed in 60% of participants, secondary to misdiagnosis and lack of appropriate referrals. Treatment delay was associated with limited local treatment capacity and securing the cost of treatment. Cost of transportation impacted all types of delays. Conclusion This is the first work that describes an evidence-based approach to identify barriers in access to care for head and neck cancer patients in sub-Saharan Africa. The insight provided by this study will be used as a guide to develop implementation strategies for early detection of head and neck cancer in low- and middle-income countries.