Unveiling disparities in cancer care: a comparative study of service availability in low- and middle-income countries (LMICs) versus high-income countries (HICs)
Ashley Wei-Ting Wang, Cristiane Decat Bergerot, Ozan Bahcivan, Dégi L. Csaba, Youngmee KimAbstract
Background:
Accessible supportive care is crucial for reducing unmet needs in cancer care and for improving cancer outcomes. However, significant disparities in supportive care resources exist between low- and middle-income countries (LMICs) and high-income countries (HICs). Health care priority is often set by health care professionals' (HCPs') evaluation about the adequacy of services and programs to meet their patients' needs. Thus, this study aimed to compare the perspectives of HCPs from LMICs versus HICs on the availability of supportive care services for patients with cancer and survivors (Aim 1). In addition, the study examined differences in service provision across four major age groups (Aim 2) and identified the types of services offered (Aim 3).
Methods:
Secondary analysis was conducted using the International Psycho-Oncology Society (IPOS) Survivorship Online Survey, targeting HCPs involved in clinical services and research with patients with cancer and survivors worldwide. The data from 177 (81 from LMICs and 96 from HICs) participants were subjected to subsequent analysis. Chi-squared tests were used to compare the availability of services for each of the 13 types of unmet needs overall and across four age groups and the types of services provided between LMICs and HICs.
Results:
HCPs from LMICs reported fewer services addressing patients' unmet needs related to sexuality/intimacy and financial concerns across all age groups and fewer services for various unmet needs (including symptom management, emotional distress, spiritual concerns, medical care, insomnia and fatigue, and personal care) of adolescents, young adults, and older adult patients, compared with HCPs from HICs. No significant differences were found between LMICs and HICs regarding service provision for middle-aged patients. Psychological counseling or psychotherapy was the most frequently provided service in both LMICs and HICs. However, HCPs from LMICs reported significantly fewer self-help materials and pharmacological services available but more support groups available for financial concerns and personal care.
Conclusions:
The study revealed significant disparities in the provision of supportive care services for patients with cancer between LMICs and HICs, highlighting the urgent need for targeted interventions and policy changes in LMICs. Future research should include broader geographical representation and focus on developing effective strategies to address critical unmet needs, particularly in sexuality/intimacy and financial concerns, to improve the quality of cancer care in LMICs.