A scoping review of palliative care delivery approaches, challenges, and context-specific strategies for cancer patients in Africa

Abstract

Background: The Global Organization Board of the Cancer Association Network projected global number of cancer cases to reach 35 million by 2050. In Africa, patients with newly diagnosed cancer are projected to double by 2030, underscoring the need for comprehensive strategies encompassing prevention, early detection, treatment, and palliative care (PC). However, PC service in Africa remains fragmented, often lacking holistic and continuous care delivery, with more emphasis on facility-based services. Objective: This scoping review aims to synthesize available evidences on PC approaches for cancer patients in Africa, challenges in PC delivery, and suggested measures to improve PC. Method: This scoping review employed the Joanna Briggs Institute review methodology. Extensive search of published and unpublished literature in English was conducted using databases including MEDLINE (PubMed), Embase (Ovid), Web of Science Core Collection, Scopus, Google Scholar, and Google. Records of 1242 were identified; after removing 309 duplicates, 933 citations were screened for abstract review using Rayyan software. Three reviewers assessed abstracts, and full texts resulting in inclusion of 27 studies. Findings: The findings are organized under three themes. The first theme addressed PC approaches in Africa, including home-based, community-based, facility-based, integrated, and comprehensive models. Despite the availability of multiple PC approaches, most countries in Africa primarily practice pain relief, with limited adaptation of the psychological, financial, spiritual, and end-of-life care need of the patients. The second theme identifies the challenges in comprehensive PC provision that includes restrictive opioid laws, under-funding, shortages of workforce and resources, and gaps between PC needs and available services. The third theme synthesizes suggested measures for improvements which indicate the necessity of a shift toward comprehensive, patient, and caregiver centered models with smooth referral practices. These suggestions also emphasize policy reforms to improve access to medicines and funding, and education for health workers and community volunteers. Conclusion: In Africa, PC remains largely inaccessible, fragmented, and of poor quality despite the existence of different approaches. To bridge this gap, implementation of a comprehensive care model that ensures continuity of care among home, community, and facility is crucial.