Abstract
Gynaecologic cancers contribute significantly to the cancer burden in developing countries, resulting in higher mortality and morbidity rates among women in these nations. This situation is further compounded by the occurrence of wars, famine, poverty and natural disasters, and infectious diseases like hepatitis B and HIV/AIDS. In addition, merge resources and manpower lack in these countries further compound this very delicate situation. Often times, socioeconomic, cultural, and ethical factors such as truth-telling, choice of place of care, place of death, treatment choices, medication use, and terminal sedation can interfere in patient management. Availability and use of oral morphine for pain relief, spiritual care and availability of palliative care services, the individuals’ autonomy, and family and community participation in care, end of life issues, and preservation of fertility are also big issues that determine the course of care. This review discusses these pertinent factors, discusses how they affect cancer care in women, and proffers ideas for healthcare workers and policy makers on implementation of sustainable models for cancer care in developing countries. Addressing socioeconomic, cultural, and ethical issues affecting gynaecologic cancer care will aid in ensuring development of viable models of cancer care in resource-limited countries.
Highlights
Chronic medical diseases and cancers are becoming emerging diseases of public health importance in developing countries
In about 90% of cases, cervical cancer is linked to persistent genital infection with oncogenic strains of human papilloma virus (HPV)
Fertilitysparing procedures like radical trachelectomy performed in women of child-bearing age with early stage cervical cancer in developed countries [25] is largely unavailable in the developing world due to high treatment costs, equipment and expertise lack, late disease presentation, and religious taboos
Summary
Chronic medical diseases and cancers are becoming emerging diseases of public health importance in developing countries. The burden of gynaecologic cancers is on the increase worldwide but is disproportionately higher in developing than developed countries, with the former accounting for about five million new cancer diagnoses annually [1] This situation, worsened by wars, poverty, and natural disasters, is mainly due to socioeconomic and cultural factors that lead to late diagnosis, high drop-out rates from treatment, high mortality, and poor followup of cancer survivors [2,3,4]. The World Health Organization (WHO) has named palliative care as one of four strategies to cancer control, with other three being cancer prevention, early detection and diagnosis, and treatment [7] The management of these patients is often fraught with socioeconomic, cultural, and ethical dilemmas. For successful development of a viable and sustainable model of cancer care in resource-poor environments, all these issues must be dealt with
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