Dr. Eulade Rugengamanzi

Background: Cancer care involves disclosing difficult information, making treatment decisions, and advance care planning. Communication practices and preferences are strongly influenced by sociocultural context. This scoping review aims to identify, map, and appraise the available evidence on clinical communication in cancer care in Africa and recommend priorities for future work. Methods: A search strategy was developed to identify studies conducted in Africa with a primary focus on patient-clinician communication in cancer care and performed in PubMed, Embase, Web of Science, CINAHL, African Index Medicus, and PsycINFO. Two reviewers independently screened titles and abstracts, full texts, and cited references. Study characteristics were analyzed using descriptive statistics and content anal- ysis. Critical appraisal was performed using the Mixed Methods Appraisal Tool. Results: Our search yielded 58 articles from 19 countries. Study designs were quantitative survey (53%), qualitative (38%), non-randomized experimental (5%), and mixed methods (3%), with no randomized trials. Populations included patients with cancer (n = 25), doctors (n = 24), nurses (n = 16), family/caregivers (n = 16), and/or others. Seven studies (12%) focused on pediatrics. Most studies (60%) focused on clinicians’ disclosure of information, often framed as “breaking bad news” or “truth-telling.” The remainder focused on information preferences (14%), advance care planning (10%), illness understanding (5%), shared decision making (5%), and communication training (3%). Critical appraisal demonstrated higher quality among qualitative than quantitative studies. Conclusions: Future work should explore underexamined research areas such as patient-centered communication, translate observational findings into intervention development and testing, implement communication skills training, and evaluate outcomes related to communication in cancer care in Africa.

PURPOSE Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA. METHODS This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media. RESULTS A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions. CONCLUSION The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.