Journal of Cancer Policy最新文献

{"title":"Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis","authors":"Benjamin Pickwell-Smith ,&nbsp;Sarah Greenley ,&nbsp;Michael Lind ,&nbsp;Una Macleod","doi":"10.1016/j.jcpo.2023.100458","DOIUrl":"10.1016/j.jcpo.2023.100458","url":null,"abstract":"<div><h3>Introduction</h3><p>Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare.</p></div><div><h3>Methods</h3><p>We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071].</p></div><div><h3>Results</h3><p>Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24–0.99) and chemotherapy (range of odds ratios 0.70–0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay.</p></div><div><h3>Policy summary</h3><p>Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100458"},"PeriodicalIF":1.3,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000759/pdfft?md5=db512190bee39b2c2fd83ff809fcfb31&pid=1-s2.0-S2213538323000759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tailored approach to horizon scanning for cancer medicines","authors":"Jennifer A. Soon ,&nbsp;Yat Hang To ,&nbsp;Marliese Alexander ,&nbsp;Karen Trapani ,&nbsp;Paolo A. Ascierto ,&nbsp;Sophy Athan ,&nbsp;Michael P. Brown ,&nbsp;Matthew Burge ,&nbsp;Andrew Haydon ,&nbsp;Brett Hughes ,&nbsp;Malinda Itchins ,&nbsp;Thomas John ,&nbsp;Steven Kao ,&nbsp;Miriam Koopman ,&nbsp;Bob T. Li ,&nbsp;Georgina V. Long ,&nbsp;Jonathan M. Loree ,&nbsp;Ben Markman ,&nbsp;Tarek M. Meniawy ,&nbsp;Alexander M. Menzies ,&nbsp;Maarten IJzerman","doi":"10.1016/j.jcpo.2023.100441","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100441","url":null,"abstract":"<div><h3>Background</h3><p>Horizon scanning (HS) is the systematic identification of emerging therapies to inform policy and decision-makers. We developed an agile and tailored HS methodology that combined multi-criteria decision analysis weighting and Delphi rounds. As secondary objectives, we aimed to identify new medicines in melanoma, non-small cell lung cancer and colorectal cancer most likely to impact the Australian government’s pharmaceutical budget by 2025 and to compare clinician and consumer priorities in cancer medicine reimbursement.</p></div><div><h3>Method</h3><p>Three cancer-specific clinician panels (total n = 27) and a consumer panel (n = 7) were formed. Six prioritisation criteria were developed with consumer input. Criteria weightings were elicited using the Analytic Hierarchy Process (AHP). Candidate medicines were identified and filtered from a primary database and validated against secondary and tertiary sources. Clinician panels participated in a three-round Delphi survey to identify and score the top five medicines in each cancer type.</p></div><div><h3>Results</h3><p>The AHP and Delphi process was completed in eight weeks. Prioritisation criteria focused on toxicity, quality of life (QoL), cost savings, strength of evidence, survival, and unmet need. In both curative and non-curative settings, consumers prioritised toxicity and QoL over survival gains, whereas clinicians prioritised survival. HS results project the ongoing prevalence of high-cost medicines. Since completion in October 2021, the HS has identified 70 % of relevant medicines submitted for Pharmaceutical Benefit Advisory Committee assessment and 60% of the medicines that received a positive recommendation.</p></div><div><h3>Conclusion</h3><p>Tested in the Australian context, our method appears to be an efficient and flexible approach to HS that can be tailored to address specific disease types by using elicited weights to prioritise according to incremental value from both a consumer and clinical perspective.</p></div><div><h3>Policy summary</h3><p>Since HS is of global interest, our example provides a reproducible blueprint for adaptation to other healthcare settings that integrates consumer input and priorities.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100441"},"PeriodicalIF":1.3,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000589/pdfft?md5=5b759bf500a25d441a32b97d74da1dd7&pid=1-s2.0-S2213538323000589-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138436220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promise of POSIT: Real-world application of the Paediatric Oncology System Integration Tool","authors":"Laura Carson ,&nbsp;Kadia Petricca ,&nbsp;Avram Denburg","doi":"10.1016/j.jcpo.2023.100454","DOIUrl":"10.1016/j.jcpo.2023.100454","url":null,"abstract":"<div><p>Childhood cancer presents significant acute and long-term challenges for patients,families, communities, and health systems<span><span><span>. Although meaningful strides have been made in research and treatment, severe outcome </span>disparities prevail between low- and middle-income countries (LMICs) and high-income countries (HICs), with childhood </span>cancer survival rates lower than 20% in LMICs, as compared with over 80% across many HICs. In recent years, greater emphasis has been placed on health system strengthening as a means to develop domestic policy and capacity for sustainable improvements in childhood cancer outcomes in LMICs. In pursuit of a systems approach to childhood cancer in LMICs, our research team developed the Paediatric Oncology System Integration Tool (POSIT)—the first comprehensive framework for the design and evaluation of childhood cancer systems. Since its development, POSIT has been applied in an exploration of key determinants of access to essential childhood cancer medicines across two separate multi-site studies. In this commentary, we explore the value of the POSIT framework and toolkit as a constructive systems-level guide for examining interactions between childhood cancer-specific programs and encompassing health system. socio-political, and economic contexts.</span></p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100454"},"PeriodicalIF":1.3,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The views of cancer patients of Turkish, Moroccan, Surinamese, and Dutch-Caribbean descent on diagnosis, treatment and prognosis: A systematic literature review","authors":"Asiye Gedik ,&nbsp;Esther van Meerten ,&nbsp;Milou J.P. Reuvers ,&nbsp;Olga Husson ,&nbsp;Winette T.A. van der Graaf","doi":"10.1016/j.jcpo.2023.100455","DOIUrl":"10.1016/j.jcpo.2023.100455","url":null,"abstract":"<div><h3>Background</h3><p>The number of international migrants is increasing worldwide. The four major non-western ethnic groups in the Netherlands are Turkish, Moroccan, Surinamese, and Dutch-Caribbean. This review examined the scientific literature on the views of cancer patients from these four ethnic groups on cancer diagnosis, treatment, and prognosis.</p></div><div><h3>Methods</h3><p>A systematic literature review was conducted using the databases EMBASE, Medline Web of Science, and Cochrane Central Register. Studies with patients who were of Turkish, Moroccan, Surinamese, and Dutch-Caribbean descent were included. Both qualitative and quantitative studies were included, and thematic analysis was performed. The methodological quality was assessed using the Mixed Methods Appraisal Tool.</p></div><div><h3>Results</h3><p>Thirteen studies were conducted in Turkey on Turkish cancer patients, while three were conducted in the Netherlands on Turkish and Moroccan cancer patients. Four themes emerged from the included studies: disclosure of diagnosis, communication, information provision, and decision-making. The majority of cancer patients in Turkey wanted information regarding their diagnosis and treatment. However, disclosure of a cancer diagnosis was rarely discussed with cancer patients in Turkey, whereas in the Netherlands it was provided directly. Family members in both the host and native countries had a strong influence on communication and decision-making. No literature on this topic for Surinamese or Dutch-Caribbean cancer patients was found.</p></div><div><h3>Conclusion</h3><p>Although major ethnic groups live in host countries, there is a lack of knowledge on optimal communication and information disclosure on cancer to patients and their families.</p></div><div><h3>Policy summary</h3><p>Further research into the views of ethnic groups on how to communicate about cancer is essential to ensuring that every patient receives optimal care and treatment.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100455"},"PeriodicalIF":1.3,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000723/pdfft?md5=d2ff0e2a2951c79faf00859a59d827eb&pid=1-s2.0-S2213538323000723-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV knowledge and information access among women cancer survivors in Nigeria","authors":"Candidus Nwakasi ,&nbsp;Darlingtina Esiaka ,&nbsp;Theresa Staab ,&nbsp;Aaron Akpu Philip ,&nbsp;Chizobam Nweke","doi":"10.1016/j.jcpo.2023.100456","DOIUrl":"10.1016/j.jcpo.2023.100456","url":null,"abstract":"<div><p><span>Women in Nigeria have a high burden of diseases, such as cancer and HIV. Nigerian women also have inadequate access to health information, especially for disease prevention and health promotion. Researchers have indicated that living with HIV can be particularly harmful to the health and survival of cancer survivors. However, there is a dearth of research on Nigerian women cancer survivors’ knowledge of cancer and HIV linkage and their access to HIV health information. This knowledge gap may have negative health consequences. Therefore, there is a need to ensure </span>HIV prevention among Nigerian women cancer survivors by improving access to health information. This study used a qualitative descriptive method to examine HIV knowledge and access to health information among women cancer survivors in Nigeria. Semi-structured interviews were conducted with a purposive sample of 30 women cancer survivors from Abuja, Nigeria. We identified three themes from the data, illuminating women’s knowledge of the connection between HIV and cancer. The themes include: (a) perception of HIV versus cancer which described views of HIV and cancer as distinct health conditions, (b) perceived effect of HIV on cancer given that HIV can worsen cancer outcomes, and (c) sourcing for HIV health information which highlighted issues of inadequate or inaccessible HIV-cancer information. Our findings showed that targeted health education interventions are required to address the lack of HIV information among cancer survivors.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100456"},"PeriodicalIF":1.3,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social vulnerability and lung malignancy mortality","authors":"Ramzi Ibrahim ,&nbsp;Lewjain Sakr ,&nbsp;Jennifer A. Lewis ,&nbsp;Roger Y. Kim ,&nbsp;Bryan S. Benn ,&nbsp;See-Wei Low","doi":"10.1016/j.jcpo.2023.100453","DOIUrl":"10.1016/j.jcpo.2023.100453","url":null,"abstract":"<div><h3>Introduction</h3><p>Lung cancer is a major cause of death in the United States. Social determinants of health<span><span> (SDOH) are important factors that impact the treatment and prognosis of lung cancer. The social vulnerability index (SVI) is a validated measure of SDOH. This cross-sectional study aimed to investigate the impact of the SVI on lung cancer mortality using </span>descriptive epidemiology.</span></p></div><div><h3>Methods</h3><p>Mortality data for lung malignancies from 2014 to 2018 was obtained from the CDC database and was age-adjusted and standardized to the population in the year 2000. The SVI for the same years was obtained from the CDC Agency for Toxic Substances and Disease Registry database. Age-adjusted mortality rates (AAMR) were estimated for each SVI quartile (SVI-Q) and demographic subgroup.</p></div><div><h3>Results</h3><p>We found that counties in SVI-Q4 (most vulnerable) had a higher cumulative AAMR compared to counties in SVI-Q1 (least vulnerable), accounting for a 4.48 excess death rate per 100,000 person-years. AAMR among males in SVI-Q4 was higher compared to SVI-Q1, accounting for a 9.96 excess death rate per 100,000 person-years, whereas no mortality differences were observed for female populations between SVI-Q4 and SVI-Q1. AAMR in SVI-Q4 was higher for both Hispanic and non-Hispanic populations, except for American Indian/Alaska Native populations. Similar trends were observed in both metropolitan and non-metropolitan counties.</p></div><div><h3>Conclusion</h3><p>Our study suggests that the SVI may play a significant role in lung cancer mortality and highlights the need for interventions targeting vulnerable populations to improve outcomes.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100453"},"PeriodicalIF":1.3,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a ‘Living with Cancer’ programme in a rural and coastal setting: Experiences of collaborative and innovative co-production across an Integrated Health System","authors":"Kathie McPeake ,&nbsp;Louise Jeanes ,&nbsp;David Nelson ,&nbsp;Peter Selby ,&nbsp;Samuel Cooke ,&nbsp;Mark Gussy ,&nbsp;Ros Kane","doi":"10.1016/j.jcpo.2023.100452","DOIUrl":"10.1016/j.jcpo.2023.100452","url":null,"abstract":"<div><h3>Introduction</h3><p>With projected increases in cancer prevalence, and demonstrated unmet need, there is an urgency for a collaborative approach to improving the lives of those living with cancer particularly in rural and coastal areas where cancer survivors face unique challenges. We report on an innovative ‘Living with Cancer’ (LWC) programme in the rural and coastal English county of Lincolnshire.</p></div><div><h3>Methods</h3><p>In 2016, the Lincolnshire LWC programme was established to develop person-centred, local support for people living with cancer, their carers and significant others in Lincolnshire. This article reports on the setup of the LWC programme, our innovative approach to delivering cancer care in a rural and coastal setting, as well as our most salient achievements.</p></div><div><h3>Results</h3><p>This work, developed within a policy context of tackling health inequalities and personalised approaches to care, started with stakeholder and community engagement where people described the challenges to living well after cancer and the need to focus on 8 themes further exacerbated by rurality. Recognising the limitations of conventional approaches, led to the development of a strategy underpinned by a shared set of principles and a philosophy of the importance of a transformative, whole-system, place-based, asset-based, and person-centred approaches. The strategy is now being coordinated and delivered across all cancer pathways and Lincolnshire communities. In 2022, permanent funding was secured, and our success was also demonstrated by a national Macmillan Integration Excellence award.</p></div><div><h3>Discussion</h3><p>The initial success of the LWC programme in Lincolnshire is a result of an explicit focus on ‘transformation’ rather than ‘improvement’, and a programme not solely situated in an acute setting, which needed a whole systems approach with a focus on person-centred support and community engagement.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100452"},"PeriodicalIF":1.3,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000693/pdfft?md5=bcab42a12b778cce46322b8e2e173f5e&pid=1-s2.0-S2213538323000693-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian experience with the use of monitoring registers attached to negotiated agreements (MEAs) of the Italian Medicines Agency is a tool for governance and clinical appropriateness","authors":"Maurizio Capuozzo ,&nbsp;Venere Celotto ,&nbsp;Alessandro Ottaiano ,&nbsp;Andrea Zovi ,&nbsp;Roberto Langella ,&nbsp;Francesco Ferrara","doi":"10.1016/j.jcpo.2023.100450","DOIUrl":"10.1016/j.jcpo.2023.100450","url":null,"abstract":"<div><p>The use of monitoring registers with annexed negotiation agreements (MEAs) of the Italian Medicines Agency (AIFA) are the pillar of Italian healthcare governance to guarantee the correct allocation of economic healthcare resources. In Italy, an analysis was conducted in the context of a local health authority where all negotiation activities were implemented to verify the amount of reimbursements that can be recovered through the use of all available procedures on the monitoring registers. The purpose of this analysis was to highlight any criticalities which, if not properly addressed by doctors and pharmacists, can lead to considerable financial loss. Correct verification by the hospital pharmacy resulted in an economic recovery of approximately EUR 579,443.40 for the year 2022 and EUR 682,225.30 in the first 9 months of 2023. This analysis is intended to highlight how effective collaboration between doctors and pharmacists can lead to clear economic advantages with an efficient health system to the total benefit of citizens.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100450"},"PeriodicalIF":1.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Starting and stopping cancer drugs: The need for randomized trials","authors":"David J. Benjamin,&nbsp;Vinay Prasad","doi":"10.1016/j.jcpo.2023.100451","DOIUrl":"10.1016/j.jcpo.2023.100451","url":null,"abstract":"<div><p>Precision oncology has gained widespread popularity over the past decade, and increasingly oncologists strive to provide the right treatment to the right patient. To date, precision efforts have focused on the specific mutational target(s), food/ drug interactions, functional oncology, or dose of drug given. Moreover, the tumor and blood samples of hundreds of thousands of patients with cancer have been sequenced in the United States alone with the goal of identifying and prescribing the most precise treatment. Despite this broad consideration of precision oncology, one neglected aspect of precision oncology is identifying the optimal start time and stopping point for cancer therapies. Is it possible to improve overall survival (OS) or quality of life for patients with more precise initiation and discontinuation of therapy? In this commentary, we review the historical basis to initiate, discontinue or switch therapies. We emphasize that largely these time points were selected arbitrarily, and subsequently constrained by historical accident. We highlight randomized efforts to better elucidate the time points in starting or stopping therapy. Finally, we provide suggestions for a research agenda on precision timing of anti-cancer drugs.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100451"},"PeriodicalIF":1.3,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer patient experiences in the Botswana health system: Is it time for patient navigators?","authors":"Kirthana Sharma ,&nbsp;Leyla Baghirova-Busang ,&nbsp;Shaheen Abkenari ,&nbsp;Godwill Gulubane ,&nbsp;Charmi Rana ,&nbsp;Peter Vuylsteke ,&nbsp;Richard Marlink ,&nbsp;Tendani Gaolathe ,&nbsp;Tiny Masupe","doi":"10.1016/j.jcpo.2023.100449","DOIUrl":"10.1016/j.jcpo.2023.100449","url":null,"abstract":"<div><h3>Background</h3><p>New models of care are required to support women with breast cancer due to rising incidence and mortality in sub-Saharan Africa (SSA). This study gives voice to the experiences of advanced-stage breast cancer patients in the Botswana healthcare system, to guide improved service provision and the potential utility of patient navigator (PN) programs.</p></div><div><h3>Methods</h3><p>focus group discussions (FGD) were conducted with advanced-stage breast cancer patients recruited from the oncology ward of the public Princess Marina Hospital located in Gaborone, Botswana.</p></div><div><h3>Results</h3><p>FGDs included 7 female breast cancer patients and their 7 caregivers (2 male and 5 females). Findings fell into the following themes: experiences with cancer diagnosis, experiences with treatment, roles of caregivers, information needs, views on cancer resources, and attitudes towards cancer research. The study identified several barriers across the cascade of care for breast cancer patients in the Botswana health system. These correspond to challenges with timely diagnosis and comprehensive management and highlight community level barriers to achieving the targets of the WHO Global Breast Cancer initiative (GBCI).</p></div><div><h3>Conclusion</h3><p>The study findings suggest PN programs have the potential to bridge barriers identified in the Botswana healthcare system by improving communication, meeting information needs, providing emotional or practical support, and by addressing logistical barriers to cancer diagnosis and treatment in Botswana.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"38 ","pages":"Article 100449"},"PeriodicalIF":1.3,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61565489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}