Radiation Oncology, Te Whatu Ora Health NZ MidCentral, Palmerston North, New Zealand
ZAMBART, Lusaka, Zambia.
BMJ Open. 2023 Apr 13;13(4):e067715. doi: 10.1136/bmjopen-2022-067715.
Late presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA.
Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool.
PubMed and Embase, for publications from January 1995 to March 2021.
Inclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries.
paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways).
Two reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes.
57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines.
Robust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.
在撒哈拉以南非洲（SSA），晚期表现以及诊断和治疗的延迟通常会导致较差的结果。本研究旨在整理和评估影响 SSA 成人实体瘤诊断和治疗延迟的因素。
系统评价，使用非随机暴露研究的偏倚风险（ROBINS-E）工具评估偏倚。
PubMed 和 Embase，检索时间为 1995 年 1 月至 2021 年 3 月。
纳入标准：定量或混合方法研究，发表于英语期刊，研究对象为 SSA 国家的实体癌。
儿科人群、血液恶性肿瘤，以及对癌症公众认知和意识的评估（因为重点是癌症诊断和治疗途径的患者）。
两位评审员提取和验证了研究。数据包括出版年份、国家、人口统计学特征、国家层面的环境、疾病部位、研究设计、延迟类型、延迟原因和主要结局。
对 193 篇全文综述进行了 57 篇的筛选。40%的研究来自尼日利亚或埃塞俄比亚。70%的研究集中在乳腺癌或宫颈癌。43 项研究在质量评估的初步阶段存在较高的偏倚风险。14 项研究符合全面评估标准，在七个领域中均存在高或极高的偏倚风险。延迟的原因包括诊断和治疗服务费用高、初级、二级和三级医疗保健部门之间缺乏协调、人员配备不足、以及对传统治疗师和补充药物的持续依赖。
关于 SSA 优质癌症护理障碍的有力研究缺乏。大多数研究的重点是乳腺癌和宫颈癌。研究成果来自少数几个国家。当务之急是调查这些因素的复杂相互作用，以建立有弹性和有效的癌症控制计划。
