Table 1.

Summary of cancer care delivery gaps and possible system-level interventions in the US and low and middle income countries (LMICs)

Care Gap	United States	LMIC	US System Interventions	LMIC System Interventions
Advanced stage at diagnosis	Yes	Yes	Free screening programs Medicaid expansion Increased insurance access	Breast health awareness education and improved early diagnosis strategies
Delayed or Inadequate surgery	Yes	Yes	Insurance access Medicaid policy change Patient navigation QI programs EHR alerts	Address timely access to cancer surgery without requiring patients to pay privately out of pocket
Delayed or No radiation	Yes	Yes	Patient navigation Audit and Feedback QI programs EHR alerts	Determine if radiation therapy is available in country and then properly triage patients for timely treatment
Lack of chemo therapy/biologics	No	Yes	–	Assess access to drugs on WHO’s Essential Medicine List and improve availability at decreased cost through collective bargaining
Chemo under-dosing or non-standard agents; early discontinuation	Yes	Yes	Audit and Feedback Clinical Pathways QI Programs	Assess proper drug utilization and delivery in existing systems and evaluate quality control
Lack of endocrine therapy	Yes	Yes	Pharmacy system alerts Patient navigation Co-pay assistance	Establish estrogen-receptor testing availability and secure tamoxifen and generic aromatase inhibitor access for properly selected patients