Patients with cancer in low-income nations present for surgical treatment at a young age, advanced stage of disease, and often receive palliative rather than curative procedures, suggests a study in Malawi.
"The small number of surgeons in most developing countries makes access to surgical care a major barrier to cancer care," report the study's authors in the Archives of Surgery.
Less than a fifth of cancers in the study were diagnosed based on histologic analysis, cytologic testing, or laboratory values, note the researchers, highlighting some of the barriers to providing basic cancer surgical services aside from surgeons and supplies.
"Patients require an accurate cancer diagnosis and appropriate cancer staging to optimize surgical decision making," say Peter Kingham (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues.
The team examined 28 months of operating room logbooks from Malawi that revealed 1440 general and urologic operations, 17.8% of which resulted in a diagnosis suggestive of cancer. The most common cancers overall were prostate, esophageal, gastric, breast, and colon.
The mean age at presentation was 53 years, note the authors, with 80.0%, 77.8%, and 51.7% of testicular, breast, and colon cancer patients presenting under the age of 50 years. The respective proportion of US adults diagnosed with these cancers under the age of 50 years is 86.0%, 22.0%, and 9.0%, according to 2006 Surveillance, Epidemiology, and End Results data.
Gastrointestinal cancer procedures were especially likely to be undertaken with a palliative intent, with 76.0% of esophageal cancer patients receiving palliative gastric feeding tubes during their procedure. Furthermore, just 29.4% of colorectal cancer patients could be treated curatively.
Kingham and co-writers suggest "four key strategies" for low-resource settings: improvement of pathology services, for example virtual pathology laboratories using telepathology; improvement of radiology services including teleoncology initiatives and access to less expensive imaging tools; improved data collection, for example, a data card carrying basic patient information; and modified guideline implementation, such as the Breast Health Global Initiative.
"General surgeons and surgical oncologists in the developed world can fill a major void by increasing awareness, collaborating globally, and supporting surgical colleagues in developing countries," concludes the team.
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