"Critical issues detrimental to a cooperative cancer treatment:  Perspectives of Radiation oncologists and Raditional Health Practitioners in KwaZulu-Natal, South Africa"

Abstract

Introduction / Background: The mortality and morbidity as a result of cancer is expected to escalate in the coming decades due to the increase in cancer occurences globally. The most common treatment for cancer provided by the Radiation Oncologists (ROs) is radiation therapy. In developing countries where there are constrained radiotherapy resources, patients consult concurrently with Traditional Health Practitioners (THPs) and Radiation Oncologists (ROs) for cure or relief from the cancer. Consequently, there are interruptions of treatment and patients present with advanced cancer. Studies have shown that cooperative practice in cancer treatment is crucial for continuity of care. However, there is lack of information on critical issues that can be detrimental to a cooperative practice in cancer treatment. The current study explored those issues as perceived by THPs and ROs in KwaZulu-Natal (KZN), South Africa.
 Methods: A qualitative case study approach was utilised in this study. This is part of a bigger study conducted to develop a framework for a cooperative practice cancer treatment between THPs and ROs in KZN. Five focus group interviews were conducted with 28 THPs who were selected using snowball. Those were the THPs from eight of 11 districts in KZN who were practising and involved in the treatment of cancer. Furthermore, individual interviews were conducted to collect data from four purposively selected ROs employed at public oncology hospitals. Using a framework analysis, data were analysed to identify themes.
 Results: The THPs were classified as traditional herbalists, diviners and spiritual healers who were involved in the treatment of patients with cancer. On the other hand, four of seven ROs employed at public hospitals, agreed to participate in the study. With regards to issues detrimental to a cooperative cancer treatment, the emergent themes included lack of relationship, team work, respect and trust, communication, patient involvement in treatment decision making, and delays in patient referrals. 
 Discussion: Despite the ROs’ concern about the role of THPs in cancer treatment, both parties are willing to work together. The issues detrimental to a cooperative practice in cancer treatment between THPs and ROs, need to be rectified. The THPs indicated the desire to build a relationship with the ROs. They felt this would allow them to be able to refer patients to the ROs to confirm a diagnosis before commencing treatment, evaluate their treatments, and provide further treatment if their initial treatment was unsuccessful.
 
 Conclusion: Based on the findings of the study, it can be concluded that the THPs and ROs should operate as parallel systems but have a working relationship in order to facilitate the movement of cancer patients between them and ensure that there is continuity of care.
 Furthermore, cooperation can be encouraged through formal government policies, and that a representative for THPs is needed in all government structures associated with cancer treatment.