Exploring Global Barriers to Optimal Ovarian Cancer Care: Thematic Analysis

Ovarian cancer has a high mortality rate, with a great deal of variation both within countries and between countries; thehighest mortality rates are observed in countries with pooraccess to healthcare. Previous research has suggested thatdisparities in survival rates can stem from stage differencesat the time of diagnosis, but in addition to this, there areobservable differences that remain within each stage. This suggests additional sources of the inequality, and this studywas designed to evaluate barriers for physicians in treating ovarian cancer across different hospitals, regions, and coun-tries, providing a qualitative review of perceptions of these barriers. Additionally, the study was designed to extrapolatemajor areas for improvement in managing ovarian cancer globally as well as ways to address the disparities and comeup with solutions.Data for this study were obtained from the Global Equity in Ovarian Cancer Care expert opinion survey study. The survey wasdistributed in 5 languages, with responses all translated into English. This data analysis focused on responses to the question:"What are the main barriers to optimal ovarian cancer care in your hospital, region, or country?Please provide any further com-ments in the space below."Final analysis included responses from 1059 physicians from 115 countries, 83% of whom were gynecological cancer sur-geons, 8% of whom were obstetricians/gynecologists, and 9% of whom were other specialists. A total of 5 themes were iden-tified among the responses, including societal factors, inadequate resources in hospitals, economic barriers to treatment, or-ganization of the specialty, and the need for early detection. Societal factors often included a country's political climate, suchas war and conflict between countries, but also conflict between public and private healthcare systems, geographic location ofpatients and access to care dependent on location, and a lack of healthcare for rural populations. Hospitals vary in their re-sources such as specialty-trained staff and an inability to accommodate for increasing demand of care. Some countries alsohave suffered from the impact of COVID-19 and lack other resources such as access to diagnostic testing including pathologyand radiology services, as well as genetic counseling and molecular testing facilities.Economic barriers to treatment were a significant theme, with the cost of treatment being significant regardless of income,resulting in patients not receiving treatment due to an inability to afford care. Newer treatments are also more difficult to ac-cess in lower income settings, with some being completely unavailable. Another barrier identified by the survey was the over-all organization of gynecological oncology as a medical specialty, with great variability in standards of care. Clear guidelineshave been released only in some countries, and compliance and access to guidelines remain variable even in countries thathave released them.The last identified barrier was the need for early detection; the complexity of management for cases of ovarian cancer in-creases with cancer stage, and thus more resources are required to manage cases that have advanced farther. Potential solu-tions given among the comments included campaigning for public health awareness and educational programs about ovariancancer in communities, as well as education efforts by primary care physicians.These results broaden the overall picture of barriers to accessing treatment for ovarian cancer and provide one of the firstglobal assessments of such barriers.Many previous studies have focused only on specific countries or issues rather than abroader perspective. Other studies have also supported some of the potential solutions identified in this study, such as central-ized approaches to care, specialized training, and standardized clinical practice guidelines. Future research should focus onremoving participant bias, minimizing underreporting, and qualitative analysis that will show more specifics on the most ma-jor disparities and possibilities for addressing them.