Bajwa Anmol, Chidebe Runcie C W, Adams Tracey, Funston Garth, Soerjomataram Isabelle, Cohen Robin, Adel Rafe Sadnan, Phan Ngoc, Kaidarova Dilyara, Bolatbekova Raikhan, Refky Basel, Noll Florencia, Eiken Mary, Origa Martin, Mukhopadhyay Asima, Nasser Sara, Lau Iren, Konney Thomas, Shaffi Afrin Fatima, Makondi Precious Takondwa, Woo Yin Ling, Rangeiro Ricardina, Mustapha Aisha, Msadabwe Susan, Benhima Nada, Zahirova Nargiza, Andrade Carlos Eduardo Mattos Cunha, Pareja Rene, Cantú de León David, Chávez-Chirinos Carlos, Bambury Ian, Pervin Shahana, Pariyar Jitendra, Estrada Erick, Strömsholm Eva-Maria, MacKay Clara, Charlton Phaedra, Reid Frances
World Ovarian Cancer Coalition, Toronto, Canada.
Project PINK BLUE - Health & Psychological Trust Centre, Abuja, Nigeria; Department of Sociology & Gerontology & Scripps Gerontology Center, Miami University, Oxford, OH, USA.
J Cancer Policy. 2025 Jun;44:100582. doi: 10.1016/j.jcpo.2025.100582. Epub 2025 Apr 7.
Ovarian cancer poses a significant and growing burden, particularly in low- and middle-income countries (LMICs) where incidence and mortality are projected to increase by over 50 % by 2050. However, there is a critical lack of qualitative data on the challenges and opportunities for improvement in treatment and care for women with ovarian cancer in these regions. The aim of this research is to investigate clinicians' perspectives on the matter in 24 LMICs.
As part of the multi-country observational Every Woman Study™ (EWS), semi-structured interviews were conducted with clinicians between June 2022 and June 2023. The interview guide was developed by the EWS LMIC Oversight Committee, including patients, clinicians and data specialists. Relational content and inductive thematic analyses were employed and categories synthesized using the World Health Organization's six building blocks of the Health Systems Framework.
24 clinicians (54 % female; 79 % gynaecologic oncologists, 8 % gynaecologists, 8 % clinical oncologists not specializing in gynaecological cancers, and 4 % clinical oncologists specializing in gynaecological cancers; 42 % from Africa, 29 % from Asia, 29 % from Latin America) participated. Six dominant themes were identified: "Poor Ovarian Cancer Data'', "Inequity in Access to Treatment", "In-Country Inequities in Access to Care", "Role of Cultural Norms on Women's Health", "Increased Engagement of Men in Ovarian Cancer Control", and "Advocacy and Education for Empowering Women". Content analysis revealed system-level challenges such as delayed drug payments, lack of population-based cancer data, and limited imaging facilities. Patient-level challenges included disparities in access to specialists, limited medication affordability, poor symptom recognition, and reliance on alternative treatments.
This study reveals the complexity of ovarian cancer treatment and care in LMICs and the need to mitigate disparities in these regions, underscoring the need for patient-centred, context specific and intersectoral strategies to be considered in cancer planning to improve ovarian cancer care quality and equity in LMICs.
卵巢癌造成的负担日益加重，在低收入和中等收入国家（LMICs）尤为明显，预计到2050年，这些国家的发病率和死亡率将增长超过50%。然而，关于这些地区卵巢癌女性患者在治疗和护理方面面临的挑战及改善机会的定性数据严重匮乏。本研究旨在调查24个低收入和中等收入国家临床医生对此事的看法。
作为多国观察性“每个女性研究”（EWS）的一部分，于2022年6月至2023年6月期间对临床医生进行了半结构化访谈。访谈指南由EWS低收入和中等收入国家监督委员会制定，该委员会成员包括患者、临床医生和数据专家。采用关系内容分析和归纳主题分析，并使用世界卫生组织卫生系统框架的六个组成部分对类别进行综合。
24名临床医生参与了研究（54%为女性；79%为妇科肿瘤学家，8%为妇科医生，8%为非妇科癌症专科的临床肿瘤学家，4%为妇科癌症专科的临床肿瘤学家；42%来自非洲，29%来自亚洲，29%来自拉丁美洲）。确定了六个主要主题：“卵巢癌数据匮乏”、“治疗可及性不平等”、“国内医疗服务可及性不平等”、“文化规范对女性健康的影响”、“男性更多参与卵巢癌防治”以及“增强女性权能的宣传与教育”。内容分析揭示了系统层面的挑战，如药物支付延迟、缺乏基于人群的癌症数据以及影像设施有限。患者层面的挑战包括专科医生可及性差异、药物可负担性有限、症状识别不佳以及对替代疗法的依赖。
本研究揭示了低收入和中等收入国家卵巢癌治疗和护理的复杂性，以及减少这些地区差异的必要性，强调在癌症规划中需要考虑以患者为中心、因地制宜和跨部门的策略，以提高低收入和中等收入国家卵巢癌护理质量和公平性。
