Adjuvant therapy for brain tumors in LMICs: A systematic review of barriers and possible solutions

• Published in: Clinical neurology and neurosurgery Vol. 244; p. 108460
• Main Authors: Shakir, Muhammad, Irshad, Hammad Atif, Khowaja, Aly Hamza, Tahir, Izza, Shariq, Syeda Fatima, Rae, Ali I., Hamzah, Radzi, Gupta, Saksham, Park, Kee B., Enam, Syed Ather
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2024; Elsevier Limited
• Subjects: Adjuvant therapy; Adjuvants; Anesthesia; Brain cancer; Brain tumors; Chemotherapy; developing country; Information management; Infrastructure; Insurance policies; Mortality; Nervous system; Oncology; Patients; Radiation therapy; radiotherapy; Surgery; Systematic review; Tumors; Workforce; LMIC; radiotherapy; developing country; NSOAP; chemotherapy
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108460

Adjuvant therapy is an important tool in the arsenal of brain tumor management and can improve patients' outcomes significantly but low- and middle-income countries (LMICs) often face challenges in provision. Therefore, our study aims to highlight barriers and strategies to adjuvant therapy of brain tumors in low-resource settings. A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains. 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs. A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs. •Adjuvant therapy is an important part of the care of brain tumors, however developing countries are unable to always offer it to their patients.•Most reported barriers within literature are found to be an overall limited access to healthcare and a lack of equipment.•Strategies to improve the quality of care include financial support through the government and the development of national treatment guidelines.