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Methodology to Study Care Barriers for Head and Neck Cancer Patients in Low- and Middle-Income Countries Yields Insights

by Linda Kossoff •

What can an evidence-based study approach using quantitative and qualitative data reveal about barriers in care access for head and neck cancer (H&NC) in lowand middle-income countries (LMICs), specifically within Dakar, Senegal?

BOTTOM LINE

Barriers in care access for H&NC patients can be categorized as delays in presentation, referral, and treatment, and insights gained suggest its feasibility and transferability in developing strategies for early detection of H&NC in LMICs.

BACKGROUND: Most new H&NC cases arise in LMICs, where patients often present with advanced disease, requiring locally unavailable treatment. In sub-Saharan Africa, H&NC’s burden is documented, yet no local strategies exist to facilitate early detection/diagnosis, and no evidence-based approach to identify care access barriers for these patients has been implemented.

STUDY DESIGN: Descriptive observational study.

SETTING: Otolaryngology–Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada.

SYNOPSIS: Researchers identified 33 patients with H&NC selected from two independent university hospitals in Dakar, Senegal. Drawing on the data collection and analysis framework they had created from their previously published review on the same topic, they collaborated with local H&NC surgeons to describe/identify the care barriers for local H&NC patients. A mixed-methods descriptive study was performed using a specifically tailored questionnaire and focused ethnographic qualitative approach to identify factors that delay patient presentation, referral, and treatment. Of the 33 patients, 91% presented with advanced disease. Average presentation delay was 5.7 months, mainly attributed to cost of consultation (39%), waiting time at the doctor’s office (15%), and distance to healthcare facility (12%). Authors cite the misunderstanding of signs/symptoms of H&NC as another main limiting factor. Referral delay of >3 months was observed in 60% of participants, secondary to misdiagnosis and lack of appropriate referral, highlighting the importance of continuing education in the medical community. Delays to treatment were institution- and/or patient-related. Study limitations included an inability to obtain a wider representation of the Western Africa region.

CITATION: Beaudoin PL, Munden J, Faye M, et al. Identifying barriers in access to care for head and neck cancer patients: a field study in Dakar. Laryngoscope. 2022;132:1219-1223.