Strengthening breast cancer services in Vietnam

: Understanding context and challenges

Abstract

Breast cancer is a growing public health challenge in Vietnam. Incidence rates have been rising consistently over the past decade. Stage of diagnosis tends to be late and multiple barriers prevent women from accessing screening, diagnostic, and treatment services. There has been little data systematically collected on breast cancer in Vietnam, with no integrated cancer registry. Data presented on breast cancer in Vietnam tends to be based on estimations and models, and from mortality rates in neighbouring countries.

The Vietnamese government has made significant strides in improving population health over the past two decades. New challenges, however, are emerging in the form of non-communicable diseases. Breast cancer creates specific challenges for both Vietnamese women and the health system that could be alleviated with targeted interventions and reforms. It is the aim of the studies presented in this thesis to contribute to developing an evidence-base to inform future decisions with the objective of improving outcomes for women with a breast cancer diagnosis. Using a health systems approach and a broad range of research methodologies, this thesis enabled the production of a holistic overview on how the health system is currently structured and what challenges exist for breast cancer service delivery. The main results of the studies reported in this thesis show that:

1. There has been a lack of published research in both English and Vietnamese providing data on breast cancer or breast cancer service delivery in Vietnam. No qualitative studies on the experiences of women have been published.

2. A high amount of factual information on breast cancer is presented within the Vietnamese media. There is, however, a lack of visibility of women sharing their personal experiences of being diagnosed with and treated for breast cancer, and it is unclear whether information presented in the media has contributed to raising awareness about breast cancer.

3. Breast cancer service strengthening is required across all six of the WHO Health Systems Framework’s 6 Building Blocks of (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance. Breast cancer services are predominately located in centralised and specialised hospitals in major metropolitan areas. Hospitals are overcrowded, creating challenges for healthcare providers, women with a breast cancer diagnosis, and their caregivers. Strengthening lower levels of the health system to provide screening and detection services may alleviate these pressures while also reducing access barriers for women living outside of major cities. Such service extension would need to be complimented with appropriate training for healthcare workers at lower levels of the health system. Health information systems require strengthening, given the lack of an integrated national cancer registry.

4. Beyond the Building Blocks, social determinants of health must be addressed to ensure breast cancer services are accessible and appropriate. Women experience multiple challenges in accessing breast cancer services, including geographic and cultural barriers, as well as out-of-pocket expenses relating to cost of treatment. Many households face financial catastrophe after women access breast cancer services. Reforms to the insurance system that increase coverage for screening and treatment services should be explored through future costing studies, and may have the potential to help downstage diagnosis. Equally, greater awareness of dynamics around breast cancer stigma, relationship breakdown, and other social phenomena experienced by women with breast cancer, is required for effective future health messaging and interventions. Barriers to accessing treatment should be addressed prior to the extension of screening programmes.

5. Caregivers provide an essential role within the health system and could be better supported and enabled through programmes providing them with information and skills to provide care for women with a breast cancer diagnosis. Services supporting the emotional and health needs of caregivers should be developed.

Date of Award	Jul 2020
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Queen's University Belfast, Global Challenges Research Fund (GCRF), Newton Fund, Medical Research Council & Arts & Humanities Research Council
Supervisor	Michael Donnelly (Supervisor) & Lynne Lohfeld (Supervisor)