Systematic review of effective cervical cancer treatments in Small Island Developing States: A narrative synthesis

Abstract

Background: Cervical cancer is the leading cause of death in young women in developing countries which includes those in Small Island Developing States (SIDS). Some of the highest rates of cervical cancer deaths in the world occur in the Atlantic, Indian Ocean, Mediterranean, South China Seas(AIMS) and Pacific SIDS. The objective of this systematic review is to determine the range of cervical cancer treatments available in 36 of 38 SIDS who are members of the United Nations. Methods: Databases searched independently by two authors were: MEDLINE, CINAHL and Scopus. Manuscripts published between 2000-2017 were identified using a search strategy that included cervical cancer, all forms of treatment and the name of each of the selected 36 SIDS in the Caribbean, Pacific and AIMS countries. Only articles in the English language were included. Duplicates, non-relevant and those not meeting the inclusion criteria were excluded. Two authors selected and read the included articles independently and rated the methodological quality of each article. Results: From a total of 175 abstracts, 158 were excluded as duplicates and not relevant. Seventeen papers were read in full, nine were excluded as not meeting the inclusion criteria and eight manuscripts were included in the review. A narrative synthesis was considered appropriate given the heterogenous nature of the manuscripts. Seven of the eight papers were from the Caribbean SIDS underpinning evidence that treatments for cervical cancer were more developed in that region compared to the Pacific and AIMS SIDS. Surgery was available in most SIDS followed by chemotherapy with only seven (19%) SIDS, all in the Caribbean, with radiation centres. Conclusion: There is a dearth of published evidence on the details of treatments available to women with cervical cancer in 36 SIDS. With cervical cancer increasing in those parts of the world due to weak cancer prevention and control strategies, a large number of women with cervical cancer are not being treated especially in the Pacific and AIMS SIDS. More needs to be done to address treatments in the Pacific and AIMS SIDS and to increase publication of those efforts.