Abstract
Purpose
To identify the perspectives from healthcare providers about the limitations in referral, diagnosis, and treatment of lung cancer (LC) patients.
Methods
A cross-sectional study through an Internet-based survey was addressed to physicians of multidisciplinary teams in charge of LC patients from Cuba, Curacao, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Panama, and Trinidad and Tobago. The questions focused on physicians’ perspectives concerning waiting times and the availability of diagnostic and staging procedures in their settings, as well as the access to systemic therapies and continuous medical education (CME).
Results
A total of 152 physicians responded to the online questionnaire (response rate 24.9%). Delays in biopsy results were the main barrier for LC diagnosis as identified by 48.2% of the respondents, followed by patients not being referred in time (31.3%), delays for staging procedures (11.4%), and time taken for biopsy (9%). Almost one-half of physicians perceived that patients are diagnosed in advanced stages. A total of 29 respondent physicians (19.1%) reported limited access to immunohistochemical or genetic analysis for common mutations. Although 73 physicians (48.0%) confirmed that their centers provided radiotherapy and systemic therapy for their patients, immunotherapy was not available in the institutions of 30 physicians (19.7%). A total of 42 practitioners (27.6%) reported that they did not have access to CME on LC topics due to working or budget restrictions.
Conclusions
This study revealed among respondents the main barriers for an appropriate management of LC patients in the Central American and Caribbean Region. Further studies must validate these findings.
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References
Ferlay J, Ervik M, Lam F et al (2018) Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon https://gco.iarc.fr/today accessed 21 Oct 2019
Razzaghi H, Quesnel-Crooks S, Sherman R, Joseph R, Kohler B, Andall-Brereton G, Ivey MA et al (2016) Leading causes of cancer mortality – Caribbean Region, 2003-2013. MMWR Morb mortal Wkly rep 65:1395–1400. https://doi.org/10.15585/mmwr.mm6549a3externalicon
Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros M, de Vries E, Forman D (2016) Cancer patterns and trends in Central and South America. Cancer Epidemiol 44:S23–S42
Piñeros M, Abriata M, Mery L, Bray F (2017) Cancer registration for cancer control in Latin America: a status and progress report. Rev Panam Salud Publica 41:e2
Goss PE, Lee BL, Badovinac-Crnjevic T et al (2013) Planning cancer control in Latin America and the Caribbean. Lancet Oncol 14(5):391–436. https://doi.org/10.1016/S1470-2045(13)70048-2
Lence JJ, Camacho R (2006) Cáncer y transición demográfica en América Latina y el Caribe. Rev Cubana Salud Publica 32(3)
Curado MP, Bezerra de Souza DL (2014) Cancer burden in Latin America and the Caribbean. Ann Global Health 80(5):370–377. https://doi.org/10.1016/j.aogh.2014.09.009
Bingham A, Bishop A, Coffey P, Winkler J, Bradley J, Dzuba I, Agurto I (2003) Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud Publica Mex 45(3):408–416. https://doi.org/10.1590/s0036-36342003000900015
Cassim S, Chepulis L, Keenan R, Kidds J, Firth M, Lawrenson R (2019) Patient and career perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC Cancer 19:25. https://doi.org/10.1186/s12885-018-5169-9
Dunn J, Garvey G, Valery PC, Ball D, Fong KM, Vinod S, O’Connell DL, Chambers SK (2017) Barriers to lung cancer care: health professionals’ perspectives. Support Care Cancer 25:497–504. https://doi.org/10.1007/s00520-016-3428-3
Banydeen R, Rose AM, Martin D (2015) Advancing cancer control through research and cancer registry collaborations in the Caribbean. Cancer Control 22(4):520–530. https://doi.org/10.1177/107327481502200420
Jensen AR, Mainz J, Overgaard J (2002) Impact of delay on diagnosis and treatment of primary lung cancer. Acta Oncológica 41(2):147–152. https://doi.org/10.1080/028418602753669517
Bachouch I, Habouria C, Agrebi S et al (2016) Delay in diagnosis and management of lung cancer in developing countries. Eur Respir J 48(60):3085. https://doi.org/10.1183/13993003.congress-2016.PA3085
Malalasekera A, Nahm S, Blinman P et al (2018) How long is too long? A scoping review of health system delays in lung cancer. Europ Respir Rev 27:180045. https://doi.org/10.1183/16000617.0045-2018
Neal I, Cagle PT, Beasley M et al (2013) Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol 8(7):823–859. https://doi.org/10.1097/JTO.0b013e318290868f
Lindeman NI, Cagle PT, Aisner DL et al (2018) Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med 142(3):321–346. https://doi.org/10.5858/arpa.2017-0388-C
Luo YH, Luo L, Wampfler JA (2019) 5-year overall survival in patients with lung cancer eligible or ineligible for screening according to US Preventive Services Task Force criteria: a prospective, observational cohort study. Lancet Oncol 20(8):1098–1108. https://doi.org/10.1016/S1470-2045(19)30329-8
Berle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409. https://doi.org/10.1056/NEJMoa1102873
Raez LE, Nogueira A, Santos ES, dos Santos RS, Franceschini J, Ron DA, Block M, Yamaguchi N, Rolfo C (2018) Challenges in lung cancer screening in Latin America. J Glob Oncol 4:1–10. https://doi.org/10.1200/JGO.17.00040
Mazmanian PE, Davis DA, Galbraith R et al (2009) Continuing medical education effect on clinical outcomes. Effectiveness of continuing medical education. American College of Chest Physicians Evidence-Based Educational Guidelines Chest 135(3):49S–55S. https://doi.org/10.1378/chest.08-2518
Piñeros M, Sierra MS, Forman D (2016) Descriptive epidemiology of lung cancer and current status of tobacco control measures in Central and South America. Cancer Epidemiol 44(1):S90–S99. https://doi.org/10.1016/j.canep.2016.03.002
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This research was funded by Roche Central America and the Caribbean.
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Allan Ramos-Esquivel has received research grants from Roche. Aziza Maklouf-Quirós, Johayra-Simithy, Kavita Ragoobar, Karen Villamil, VivianFlores, and Marianne Chacón Araya declare that they have no conflict of interest.
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Maklouf-Quirós, A., Simithy, J., Ragoobar, K. et al. Barriers to lung cancer referral, diagnosis, and treatment in Central America and the Caribbean: the health professionals’ perspectives. Support Care Cancer 29, 751–757 (2021). https://doi.org/10.1007/s00520-020-05532-8
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DOI: https://doi.org/10.1007/s00520-020-05532-8