Abstract：
BACKGROUND: Adjuvant therapy is an important tool in the arsenal of brain tumor management and can improve patients\' outcomes significantly but low- and middle-income countries (LMICs) often face challenges in provision. Therefore, our study aims to highlight barriers and strategies to adjuvant therapy of brain tumors in low-resource settings.
METHODS: A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains.
RESULTS: 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs.
CONCLUSIONS: A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs.
METHODS: A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains.
RESULTS: 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs.
CONCLUSIONS: A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs.
摘要：
背景：辅助治疗是脑肿瘤治疗的重要工具，可以显著改善患者的预后，但低收入和中等收入国家(LMICs)在用药方面经常面临挑战。因此,我们的研究旨在强调低资源环境下脑肿瘤辅助治疗的障碍和策略.
方法：使用PubMed进行了全面的文献搜索，CINAHL,谷歌学者，还有Scopus,从成立到2022年10月20日。该综述包括对LMICs脑肿瘤辅助治疗的研究，并使用国家外科，产科,和麻醉计划(NSOAP)域。
结果：32项研究纳入综述。报道最多的辅助护理障碍是获得医疗保健的机会有限(14%)，获得化疗和放疗设备的机会有限(25%)，和传统或替代药物（11％）。改善的策略包括提高专门的放射肿瘤学培训的可用性（8％）和改善获得神经诊断和神经治疗的机会（12％）。此外,努力补贴治疗(4%)和通过卫生部提供财政保险(4%)可以帮助解决高昂的护理费用和改善获得化疗资金的机会。最后,建立文件系统和登记册(16%)，实施标准化的国家治疗指南(8%)有助于改善LMIC脑肿瘤患者的整体护理.
结论：针对劳动力的多模式战略方法，基础设施,服务交付,融资，需要信息管理来改善脑肿瘤的辅助治疗。国际合作和伙伴关系也可以在解决低收入国家的障碍和改善护理方面发挥关键作用。
方法：使用PubMed进行了全面的文献搜索，CINAHL,谷歌学者，还有Scopus,从成立到2022年10月20日。该综述包括对LMICs脑肿瘤辅助治疗的研究，并使用国家外科，产科,和麻醉计划(NSOAP)域。
结果：32项研究纳入综述。报道最多的辅助护理障碍是获得医疗保健的机会有限(14%)，获得化疗和放疗设备的机会有限(25%)，和传统或替代药物（11％）。改善的策略包括提高专门的放射肿瘤学培训的可用性（8％）和改善获得神经诊断和神经治疗的机会（12％）。此外,努力补贴治疗(4%)和通过卫生部提供财政保险(4%)可以帮助解决高昂的护理费用和改善获得化疗资金的机会。最后,建立文件系统和登记册(16%)，实施标准化的国家治疗指南(8%)有助于改善LMIC脑肿瘤患者的整体护理.
结论：针对劳动力的多模式战略方法，基础设施,服务交付,融资，需要信息管理来改善脑肿瘤的辅助治疗。国际合作和伙伴关系也可以在解决低收入国家的障碍和改善护理方面发挥关键作用。
