Nathan Brand|Liang G. Qu|Ann Chao|André Ilbawi
Delays and Barriers to Cancer Care in Low- and Middle-Income Countries: A Systematic Review
University of California, San Francisco|Columbia University|Monash University|United States Department of Health and Human Services|National Institutes of Health|Center for Global Health|National Cancer Institute|World Health Organization
abstract background advanced stage presentation patients common low middleincome countries lmics comprehensive analysis existing delays barriers lmics previously reported conducted systematic literature review comprehensively outline delays barriers identify targets future interventions provide recommendations future research field materials methods multiple electronic databases searched using standardized search strategy eligible articles language lmics published january 1 2002 november 27 2017 included studies reported cancer care intervals barriers encountered intervals associated barriers summarized cancer type geographical region results review included 316 study populations 57 lmics 142 449 studies addressed time intervals whereas 214 677 studies described barriers cancer diagnosis median intervals similar following three stages early diagnosis access 12 months b diagnostic 09 months c treatment 08 months studies lowincome countries significantly longer access intervals median 65 months compared country income groups patients breast cancer longer delay intervals patients childhood cancer significant variation existed geographic regions low health literacy reported frequently studies describing barriers cancer diagnosis associated lower education level formal employment lower income rural residence conclusion early diagnosis strategies address barriers three intervals contributing late presentation lmics standardization studying reporting delay intervals lmics needed monitor progress facilitate comparisons across settings implications practice review draws attention cancer implementation scientists globally findings highlight significant delays occur throughout cancer care continuum low middleincome countries describe common barriers cause review help shape global research agenda proposing metrics implementation studies demonstrating importance standardized reporting metrics report sets forth additional research evidence needed inform cancer control policies