Needs and challenges of physicians in the provision of childhood cancer care in Armenia: a qualitative study

Abstract

Childhood cancer is an important public health concern worldwide. Globally 2,000,000 new cases of childhood cancer occur per year, 80% of which befall to low- and middle-income countries (LMIC). Moreover, 90% of childhood cancer related deaths occur in LMIC. The available evidence speaks about high percentages of curability and survivorship from childhood cancer in high income countries. According to the Ministry of Health, the total number of childhood cancer cases registered in Armenia between 2004 and 2013 was 714. The National Center for Oncology after V.A. Fanarjian identified the most common types of childhood cancers in Armenia: hematopoetic and lymphatic system cancers (40%), brain and nervous system cancers (15%), bone tissue malignancies (11%) and kidney cancers (7%) from 2004 to 2014. Childhood cancer treatment is considered to be difficult and long-lasting. Healthcare professionals are faced with various challenges during the provision of childhood cancer treatment. The literature suggests that insufficient resources for patient care and psychological support, difficulties when providing information to the patients and their families due to emotional aspects, are among the challenges that health care providers deal with. This qualitative study aims to understand the needs and challenges faced during the provision of pediatric oncology care from the perspective of physicians treating childhood cancer. The study was conducted through semi-structured in-depth interviews with selected study participants. Purposive sampling technique was used for choosing the study participants. The study population included physicians dealing with childhood cancer: a) pediatric hematologists/oncologists, b) radiotherapists, c) pediatric surgeons and d) general chemotherapists. Three study instruments were developed based on the literature review, designed and adapted for the specific groups of respondents for whom they were intended, and translated into the Armenian language. Data were collected until saturation was reached. Qualitative conventional content analysis method with a deductive approach was used for analyzing the data from the in-depth interviews. Study findings suggest several needs in the provision of childhood cancer care such as: qualified staff shortages; need for quality trainings for staff especially for pediatric surgeons, pediatrician from ICUs; need for better hospital conditions; and unavailable resources (medication, equipment, cancer registry system) in Armenia. According to the study findings the challenges for physicians in the childhood cancer care delivery included: difficulties in communication with patients and their family members related to the bad news, tiredness, depressions, sleepless nights, heavy workload and inadequate salaries.