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Fulltext Proposal for development of a guideline in maintaining quality cancer care during and post-covid-19 in an upper middle-income country with universal health coverage

Teoh SP, Bustamam RS, Mustapha FI, Yip CH, Saad M, Somasundaram S, et al.

J Cancer Policy, 2021 Dec;30:100300.
PMID: 35559796 DOI: 10.1016/j.jcpo.2021.100300

BACKGROUND: During periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations.
METHOD: In-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders.
EXPECTED RESULTS: Findings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved.
CONCLUSION: The output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future.
POLICY SUMMARY STATEMENT: Collaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.
Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions

Shah R, Loo CE, Hanna NM, Hughes S, Mafra A, Fink H, et al.

J Cancer Policy, 2024 Jun 01;41:100486.
PMID: 38830535 DOI: 10.1016/j.jcpo.2024.100486

During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services.
Understanding breast cancer patient pathways and their impact on survival in Mexico

Ramli FI, Thokala P, Tong T, Unger-Saldaña K

J Cancer Policy, 2024 Apr 23;40:100482.
PMID: 38663531 DOI: 10.1016/j.jcpo.2024.100482

BACKGROUND: Understanding patient pathways from discovery of breast symptoms to treatment start can aid in identifying ways to improve access to timely cancer care. This study aimed to describe the patient pathways experienced by uninsured women from detection to treatment initiation for breast cancer in Mexico City and estimate the potential impact of earlier treatment on patient survival.
METHODS: We used process mining, a data analytics technique, to create maps of the patient pathways. We then compared the waiting times and pathways between patients who initially consulted a private service versus those who sought care at a public health service. Finally, we conducted scenario modelling to estimate the impact of early diagnosis and treatment on patient survival.
RESULTS: Our study revealed a common pathway followed by breast cancer patients treated at the two largest public cancer centres in Mexico City. However, patients who initially sought care in private clinics experienced shorter mean wait times for their first medical consultation (66 vs 88 days), and diagnostic confirmation of cancer (57 vs 71 days) compared to those who initially utilized public clinics. Our scenario modelling indicated that improving early diagnosis to achieve at least 60% of patients starting treatment at early stages could increase mean patient survival by up to two years.
CONCLUSION: Our study highlights the potential of process mining to inform healthcare policy for improvement of breast cancer care in Mexico. Also, our findings indicate that reducing diagnostic and treatment intervals for breast cancer patients could result in substantially better patient outcomes.
POLICY SUMMARY: This study revealed significant differences in time intervals along the pathways of women with breast cancer according to the type of health service first consulted by the patients: whether public primary care clinics or private doctors. Policies directed to reduce these inequities in access to timely cancer care are desperately needed to reduce socioeconomic disparities in breast cancer survival.
Challenges and Opportunities in Ovarian Cancer Care: A Qualitative Study of Clinician Perspectives from 24 Low- and Middle-Income Countries

Bajwa A, Chidebe RCW, Adams T, Funston G, Soerjomataram I, Cohen R, et al.

J Cancer Policy, 2025 Apr 07.
PMID: 40203992 DOI: 10.1016/j.jcpo.2025.100582

BACKGROUND: 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.
METHODS: As part of the multi-country observational Every Woman StudyTM (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.
RESULTS: 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.
CONCLUSIONS AND POLICY SUMMARY: 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.