Cancer treatment pathway and policy in Ghana: A mixed method study

Background
Cancer poses an increasing burden on health and wellbeing globally and although treatment advances have been made, there are considerable inequities in access to cancer care. This is the case in Ghana, where many people do not utilise cancer services and this represents a key concern for policymakers to address. This mixed methods research aimed to explore cancer pathways and policy in northern Ghana, a geographic area covering five regions with higher deprivation and where research is lacking.
Methods
Applying the transformative paradigm, this study combined analysis of Tamale Teaching Hospital cancer records, qualitative narrative interviews and creative activities with patients and family members, pathway mapping with clinical informants and a broader stakeholder workshop. Quantitative data was analysed in R, using multivariate logistic regression and multiple imputation for missing data. Qualitative data was analysed using reflexive thematic analysis. These findings were then triangulated at the stakeholder workshop.
Findings
High levels of treatment drop out were reported and only 27% of people completed treatment although missing data was common, limiting further analysis. Better understanding of the patient pathway was gathered through clinical interviews, which indicated challenges with health system capacity and referral from rural regions. Narrative interviews highlighted both the psychological but also financial burden of cancer; participants’ creative artwork offered powerful visual reminders of these experiences. The stakeholder workshop highlighted the need to improve data collection, cross-site collaboration, health insurance coverage of cancer, and provide holistic care to meet patients psychological, social, and spiritual needs.
Discussion and conclusion
This study has highlighted the need to improve northern Ghana cancer services outcomes, affordability, and equity; unique patient insights and stakeholder suggestions offer clear opportunities to make policy and practice change. Closer working with communities and establishing cancer surveillance in northern Ghana offer further opportunities for holistic cancer care, aligned with patient values.