# Exploring the gastric cancer care pathway in South Africa

## TL;DR

This study maps the gastric cancer care pathway in South Africa and identifies challenges and differences between public and private healthcare systems.

## Contribution

The paper provides a detailed analysis of the gastric cancer care pathway in South Africa, highlighting barriers and the role of a multidisciplinary team.

## Key findings

- A multidisciplinary team approach is used in gastric cancer care, starting with general physicians or nurses.
- Healthcare sector differences include diagnosis time, staging, and access to healthcare professionals and treatments.
- Low suspicion of gastric cancer in primary care and poor H. pylori detection are major challenges.

## Abstract

Gastric cancer (GC) diagnosis and care data in South Africa (SA) is sparse, and SA has a high GC mortality rate. Mapping the GC care pathway is needed to explore its efficacy in association with the SA GC burden and mortality.

The study aims to map the GC care pathway in SA from diagnosis to management by healthcare professionals (HCPs) involved in the GC patient journey and explore barriers and facilitators to the effective flow of the GC care pathway.

Interviews conducted with South African HCPs were the data source used in this article for analysis. General physicians (GP) were the first contact point with chain-referral sampling sourcing other clinicians.

Interviews were conducted via Microsoft Teams (MS Teams) and Google Meet with qualitative analyses via MAXQDA.

Themes identified were GC care pathway processes, public versus private healthcare system differences and care pathway challenges. Multidisciplinary team (MDT) care is practised for GC in SA, starting with the GP or nurse followed by gastroenterologist (GI), surgeon and pathologist. Thereafter, nurses, dieticians and palliative care specialists are involved. Healthcare sector differences are diagnosis time, GC staging, HCP and treatment access. Challenges include low GC index of suspicion by primary care clinicians (PCC) and Helicobacter pylori (H. pylori) detection.

A MDT approach for optimal treatment and patient care may be the best method for prolonged life.

A South African national consensus for GC care via a MDT, emphasising early diagnosis to aid in a robust treatment plan for improved patient outcomes is warranted.