Surgeons’ perspectives of factors affecting the quality of surgical cancer care in public facilities in Tanzania: findings from a qualitative interview study

Abstract

Background: Tanzania, like many countries in sub-Saharan Africa, has a growing cancer burden characterised by a high mortality.Surgery forms the cornerstone of both diagnosing and treating cancer.The availability of quality oncology surgery is necessary for better outcomes.The perspectives of surgeons on the quality of surgical oncology services within the country are vital for any improvement to be made.Methods: This qualitative study explored surgeons' perspectives on the factors affecting the quality of surgical oncology care in Tanzania.We interviewed 13 surgeons from different types of public health facilities that were identified as providing oncological surgery.The data were analysed using framework analysis.The study was approved by both local Institutional Review Board (Muhimbili University of Health and Allied Sciences and National Health Research Ethics Committee) and the University of California, San Francisco.Ethical approvals were obtained from all participating institutions in Tanzania and the United States.Results: We identified seven themes from the data, centred on the diagnosis of cancer, the surgical management of cancer and other contextual factors affecting cancer care.The provision of quality care for diagnosis was impacted by variations in diagnostic capacity and diagnostic delays in the health system.Presentation at a late stage, disparities in adjuvant and neo-adjuvant therapy and infrastructural challenges, including inadequate equipment and a lack of specialist skills, hindered the surgical management of cancer.The surgeons believed that patient factors, such as the ability to pay, were a key contributing factor to patients' cancer journeys and the care they received.