Abstract
BackgroundBreast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.
Highlights
Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment
To make the search exhaustive and identify additional articles, we looked for other sources and carried out country-by-country (48 sub-Saharan African countries) searches
The following keywords were combined by Boolean operators “AND”, “OR” and “Not” to obtain several search equations according to the databases: “Breast cancer”; “Breast carcinoma”; “Breast neoplasm”; “Breast Tumor”; “Factors”; “Determinants”; “Barriers”; “Challenges”; “Facilitators”; “Opportunities”; “Delayed treatment”; “Time-to-Treatment”; “Provider delay”; “Doctor delay”; “Treatment delay”; “Health system delay”; “Healthcare delivery”; “healthcare access”; “health service accessibility”; “Africa”; “sub-Saharan Africa”; and the names of each of the 48 sub-Saharan African countries
Summary
Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. Breast cancer is the most common cancer among women worldwide, with an estimated 6,875,099 five-year prevalent cases between 2013 and 2018 [1]. More than 67% of breast cancer deaths worldwide occur in low-and middle-income countries (LMICs), including subSaharan Africa [1]. With 55,938 estimated deaths in 2018, breast cancer is one of the leading causes of cancer death among women in sub-Saharan Africa after cervical cancer [4]. Breast cancer can be preventable and curable with early and adequate screening and management, but it is a fact that, in most developing countries, women with breast cancer are diagnosed very late, mainly due to a lack of information on early detection and insufficient access to health services [5,6,7]
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