Understanding the Barriers to Chemotherapy Treatment in Breast Cancer Patients in Armenia: a Qualitative Study

Abstract

Breast cancer (BC) is the most common type of cancer among women worldwide. It comprised 23% of all new cancer cases and 14% of all cancer deaths worldwide in 2008. The recent increase in morbidity and mortality rates of breast cancer is a great area of concern in lower-middle income countries, where the survival rates are low due to lack of awareness about the disease, late diagnoses, and lack of resources and appropriate health care infrastructure. Non-communicable diseases (NCD) contribute to 90% of all deaths in Armenia; 16% of all deaths are caused by cancer. There is no nationwide statistics on the BC rates in Armenia. According to unpublished data obtained from the Statistical Department of the National Oncology Institute after S. Fanarjyan, the incidence rate for BC in 2012 was 66.5 per 100,000, and the mortality rate was 37.4 in the same year. There are no published articles or reports about the current situation with access to and quality of breast cancer care in Armenia. The aim of the current study was to examine the process of delviery of chemotherapy and the barriers to receiving chemotherapy in BC patients, explore the cost and quality of chemotherapy drugs currently used for treating BC patients, and come up with some recommendations about how to improve chemotherapy services in Armenia. The student investigator conducted twenty two in-depth interviews among BC patients who received chemotherapy in the last 5 years, family members of BC patients, and healthcare providers, including oncologists and chemotherapists, using a semi-structured interview guide. The interviews were conducted in the capital Yerevan. Directed content analysis was used to analyze the data. The study identified several important barriers to chemotherapy in Armenia, including high cost of chemotherapy drugs paid for by patients out of pocket, queues at health care facilities, obsolete and unevenly dispersed infrastructure, outdated equipment, and lack of awareness about BC in general, screening for BC, and BC care in general population and BC patients. The study revealed that lack of professional training opportunities for healthcare providers hinders the delivery of high-quality care and leads to dissatisfaction with services among providers and patients. Poor provider-patient interaction in some of the healthcare facilities providing chemotherapy services to BC patients may further complicate the treatment process and worsen treatment outcomes. The numerous barriers to high-quality cancer care for BC patients could be at least partially overcome with the development and implementation of the national strategy on BC that would minimize the financial burden of treatment on the population and increase geographical access to care for the patients in regions, and the technical and organizational upgrade of the largest public cancer hospital in the country.