Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review.

PURPOSE: To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes. METHODS: A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria. RESULTS: A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life. CONCLUSION: Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care.

Disparities in cancer care and outcomes between racial and ethnic groups, urban and rural populations, and socioeconomic classes are well documented and represent one of the greatest forms of injustice throughout the United States. Despite the development of increasingly efficacious treatments, survival disparities have widened over time, with known impacts based on both medical factors and social determinants of health including education, neighborhood, factors, and access to care, among others. In this review, we discuss current state of inequities in access to cancer services, treatment-related financial toxicity, and disparities within the oncology workforce, all of which significantly impact the ability of clinicians to provide high quality, equitable, and guideline-compliant care for all people with cancer.