Supportive care interventions for cancer patients in low- and middle-income countries (LMICs): a scoping review

Alarming findings of psycho-socio-spiritual interventions on physical, mental, and social health for children with cancer and their families in low- and middle-income countries: a meta-analysis

Background

Children residing in low- and middle-income countries (LMICs) are at a higher risk of cancer. The provision of psycho-socio-spiritual care to address stressors accompanying a cancer diagnosis is largely unknown in these countries, and evidence on psycho-socio-spiritual interventions in LMICs remains unexplored.

Objective

This meta-analysis aimed to synthesize findings on psycho-socio-spiritual interventions for children and families with cancer in LMICs in comparison with those from resource-rich developing nations.

Design

This study employs a prospective comprehensive meta-analysis approach.

Settings

The study covers low- and middle-income countries and resource-rich developing countries as per the World Bank classification.

Participants

The participants came from a total of 18 studies that recruited 3,072 children (0-18) with cancer or their family members and carers who were included in this meta-analysis.

Methods

A systematic search of five databases PubMed, PsycINFO, CINAHL, Cochrane Databases, and a gray literature ProQuest was conducted to identify all possible hits. Following screening, data were extracted on a comprehensive list of variables to allow pooled and moderation analysis. The meta-analysis was performed via CMA-v2, the quality of the included studies was assessed via the Cochrane software "Risk of Bias-v2.0 (RoB2)", and PRISMA and AMSTAR 2 guidelines were followed throughout.

Results

A highly significant OR of 4.933 (95% CI: 3.423-7.108, p < 0.0001) indicated approximately fivefold improvement in children and families with cancer in 11 LMICs as a result of the psycho-socio-spiritual interventions. Four more LMICs showed evidence of qualitative psycho-socio-spiritual services for children with cancer. The quality of evidence was rated as 2B in most of the eligible studies. We established a model that can test >400,000 combinations of factors.

Conclusions

The childhood oncology community has been alerted on the lack of equitable holistic care for children and families with cancer in 126 out of the 137 LMICs and to seize the opportunity to target the underserved populations through development, adaptation, and investment in psycho-socio-spiritual care. Our model can aid in future studies and policy making.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023460114.

A reflective analysis on the inequities in cancer diagnosis and treatment in Latin America: a call to action for public health

Cancer continues to be a significant public health challenge in Latin America and the Caribbean (LAC), marked by rising incidence and mortality rates and a projection of increased burden by 2040. Despite the recognized importance of early diagnosis and treatment, the LAC region faces profound disparities in cancer care access due to socioeconomic, geographic, and educational barriers. These inequities are exacerbated by a lack of medical specialists, healthcare access limitations, and the distribution of resources, especially in rural areas. Social determinants of health (SDH) such as income level, educational attainment, and geographic location further contribute to delayed diagnoses and poor treatment outcomes. Addressing these barriers, recent initiatives emphasize strategies like telepathology networks, health education programs, and the establishment of cancer support networks to improve early diagnosis and quality of care. This review explores these SDH-based disparities in cancer care within LAC, examining innovative approaches aimed at reducing health inequities and improving outcomes for underserved populations. Through targeted interventions, the article highlights the critical need for policies promoting equitable access to cancer care as a fundamental public health objective in LAC.

Interventions Addressing Health Literacy in Cancer Care: A Systematic Review of Reviews

(1) Background: Interventions addressing the health literacy (HL) of people suffering from an illness such as cancer can improve the understanding of the illness and lead to better-adapted behaviors, regarding the participation in cancer screenings, adhering to the complex multimodal therapy, participating in cancer treatment, and self-managing everyday health. This study provides a review of systematic reviews that include intervention articles addressing the HL of patients, healthcare professionals, and/or organizations in cancer, to identify the factors related to their effectiveness, as well as the missing elements, in light of the recent developments in HL research and practice. (2) Methods: A literature search was performed in Embase, Pubmed, PsycINFO, and Science Direct. Existing published reviews of studies targeting the interventions in the oncology domain, and which explicitly mentioned HL as a factor/outcome, were included. (3) Results: One hundred and fifty-five studies were retrieved. Ten fit the criteria and were included in this review. (4) Conclusions: Most of the interventions addressing HL in people with cancer included the target patients' information and communication skills through education. To keep the full scope of the concept, as investigated in the recent literature, clinical applications of HL in patients with cancer should also consider organizational HL.

A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model

Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.

Operationalizing patient-centered cancer care in low- and middle-income countries

Rising cancer survival rates in low- and middle-income countries (LMICs) necessitate a paradigm shift to holistic, patient-driven care, focusing on meaningful outcomes aligned with individual values. Data, co-creation, continuous improvement, and collaboration are key. By prioritizing patient-defined metrics and patient empowerment, LMICs can transform cancer care, fostering sustained well-being beyond disease control.

Apoptosis induction in human hepatoma cell line HepG2 cells by trans- Anethole via activation of mitochondria-mediated apoptotic pathways

trans-Anethole a valuable compound derived from star anise widely used by ethnic tribals to manage numerous human diseases. In this study antiproliferative activities of trans-Anethole towards human liver cancer (HepG2), cervical cancer (HeLa) and breast cancer (MCF-7) cells were explored. trans-Anethole showed free radical scavenging potential as assessed by DNA nicking assay. trans-Anethole exhibited strong antiproliferative potential towards HepG2 cells compared to other cell lines. trans-Anethole strongly induced apoptosis in HepG2 cells by significantly upregulating the protein expressions of p53, Caspase-3 and Caspase-9 were assessed by western blotting analysis which highlighted apoptosis-inducing capacity of trans-Anethole against HepG2 cells. Rt-qPCR analysis revealed that trans- Anethole upregulated p53, caspase - 3 and - 9 in comparison to untreated HepG2 cancer cells. Moreover, trans-Anethole provoked the generation of ROS and disruption of MMP. Our research suggests that trans-Anethole may have a significant anticancer therapeutic potential for treating liver cancer.

"I Am a Human": A Process Evaluation of a Nurse-Led Community-Based, Palliative Care Program in Liberia, West Africa

Liberia is a postwar, post-Ebola, and low-income nation in West Africa with minimal to no palliative care access. In 2017, Partners In Health in collaboration with the Liberian Ministry of Health invested in the development of a nurse-led, community-based palliative care team in southeastern Maryland County at JJ Dossen Memorial Hospital. Between 2017 and 2022, the 9-member team (8 nurses, 1 physician assistant) has enrolled 142 patients under their care. This is a qualitative process evaluation eliciting the experiences, perspectives, and attitudes of patients with cancer to inform future palliative care program delivery improvement and development. Using an exploratory design, n = 8 participants were interviewed using a semi-structured guide. The sample had a mean age of 48 years with an average palliative care clinic enrollment period of 22.5 weeks at the time of interview. The interdisciplinary coding team used an applied thematic text analysis approach and identified 5 themes: history and disease progression, follow-up clinic services, psychological distress and its sources, social support, and spiritual and cultural beliefs. Implications emphasize the need for increased community engagement, primary palliative care capacity development of clinical colleagues in the region, and the support of local and national decision-makers to prioritize palliative care service expansion.