Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

Background Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low‐ and middle‐income countries (LMICs). A well‐integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task‐sharing and training of gynecologic oncologists (GynOncs). Objectives This review aimed to explore existing literature on capacity‐building for surgical management of early‐stage gynecologic cancers. Search Strategy The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. Selection Criteria Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task‐sharing, or outcomes following operation by subspecialists compared to specialists were included. Data Collection and Analysis Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. Main Results The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non‐subspecialized care, and task‐shifting/−sharing. Conclusions A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity‐building and task‐sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost‐effectiveness. Synopsis Despite the paucity of evidence surrounding task‐shifting in surgical cervical cancer care, properly contextualized, evidence‐based programs can increase capacity while scaling up gynecologic oncology.