Sub-Saharan African experience of neurosurgical oncology care: challenges and barriers encountered at 7 cancer treatment centers

OBJECTIVE Wide disparities in neurosurgical oncology care and treatment outcomes exist globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical oncology care in low-resource settings, the authors collected data on national neurosurgical capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries in sub-Saharan Africa (SSA). METHODS In April 2023, a 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 centers via REDCap to provide country- and hospital-level capacity data on neurosurgical oncology care. RESULTS Neurosurgical and neurosurgical oncology care were reported to be available in a limited number of provinces, states, regions, and counties in 6 of the 7 countries. The general neurosurgical workforce density across the 7 countries ranged from 0.03 to 0.67 per 100,000 persons, and that of the pediatric neurosurgical workforce ranged from 0 to 0.05 per 100,000 persons. Two centers had no pediatric ICUs, and the remaining 5 centers had pediatric ICUs with bed capacities between 1 and 8. One hospital had neither a CT nor an MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic histopathology staining only; molecular subtyping was available at a single center. Three hospitals offered pediatric anesthesia expertise. None of the hospitals offered subspecialty neuro-oncology care or had a pediatric neuro-oncologist. None of the 7 hospitals had formal neurocritical care, neuroradiology, or neuropathology expertise. Neither adjuvant chemotherapy nor radiotherapy was available at 3 centers. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 centers. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical oncology services, with patients making out-of-pocket payments for all services in some cases. CONCLUSIONS There are significant challenges to timely and quality neurosurgical oncology care in SSA especially for children. System-level interventions are needed to strengthen neurosurgical oncology care capacity in SSA.