Directorate of Postgraduate Studies, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Ilala District, Dar es Salaam, Tanzania.
Ocean Road Cancer Institute, Ilala District, Dar es Salaam, Tanzania.
JCO Glob Oncol. 2024 Aug;10:e2300439. doi: 10.1200/GO.23.00439.
The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.
全球癌症负担不断增加， disproportionately 对中低收入国家（LMICs）造成影响，这些国家占全球新增癌症患者和癌症死亡人数的一半以上。然而，由于医疗保健资源和基础设施有限，LMIC 卫生系统在实施综合癌症控制计划方面面临着巨大的挑战。本分析性评论探讨了资源有限的 LMIC 环境中破坏癌症控制努力的当代障碍证据。我们对针对资源有限环境的癌症控制挑战和解决方案的同行评审证据进行了全面的文献回顾。我们提供了一个概念框架，将这些障碍分类为癌症护理连续体，从提高公众意识到姑息治疗。我们还评估了为克服癌症控制方面的已确定障碍而在已发表文献中提出的基于证据的策略，包括向非专业卫生工作者转移任务、对高影响力干预措施进行战略优先排序、区域合作、患者导航系统和新的融资机制。在资源有限的环境中遏制癌症上升的浪潮，将至关重要的是发展强大的初级保健提供平台，与专门的肿瘤学护理相结合，以及灵活和有弹性的卫生系统模式，以适应当地情况。需要全球紧急承诺和投资，以消除障碍，并扩大在 LMIC 中居住的所有癌症患者获得预防、早期发现、诊断、治疗和姑息治疗服务的机会，这是一项道德义务。该评论阐明了政策行动、卫生系统加强和未来研究的优先领域，以指导国际努力实现更公平的全球癌症控制。
