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Cancer care with limited resources: Six lessons from low-income countries

by John R. Fischer, Senior Reporter | September 16, 2020
Rad Oncology

Setting up fair decision-making procedures
A procedural approach for setting priorities can settle disputes or situations where there is no consensus on which normative principles should guide healthcare rationing and resource allocation. One example is the Accountability for Reasonableness framework, which requires decisions and rationales to be transparent to the public; relevant to stakeholders including patients; and revisable under a regulated process.

Implementing proactive safeguards
Proactive safeguards protect low-income and marginalized communities that are at particularly high risk. Rwanda and Tanzania have each teamed up with partners to fully cover or subsidize out-of-pocket costs of cancer treatment for low-income individuals. Through these efforts, they have provided social support for food and transportation, patient navigation systems, and mobile health technology strategies that reduce treatment abandonment. Other potential safeguards could include expanding access to internet and devices for telemedicine, strengthening outreach and tracking systems for vulnerable patients, and increasing social work and supportive care services.

Communicating with patients and families
High-quality communication between patients and clinicians reduces anxiety and depression and is critical during the pandemic. Standardization across clinicians, skills training, and transparent objective criteria have helped providers in Rwanda and Tanzania have difficult discussions about resource limitations and prioritization decisions with patients.

Avoiding burnout
As oncologists in high-income communities are used to providing the highest standard of care, they are likely to feel morally conflicted in having to limit care during the pandemic. Interventions such as individual-level coping and resilience programs and organization-level changes can help them address moral distress and in effect, reduce risk of burnout among clinicians. Activities that build community and camaraderie among interprofessional oncology clinicians also help in this effort.

“A prolonged period of macroeconomic effects, such as unemployment and reduced public sector healthcare expenditures, may lead to excess cancer-related deaths on a large scale,” wrote the authors. “As oncology practices adapt to a contracted health care system, using principled approaches and the wealth of experiences in oncology resource prioritization from LMICs may help guide decisions and implementation.”

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