Cancer Demographics and Time-to-Care in Belize

Abstract

Background: Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps.

Patients and methods: Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022.

Results: During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy.

Conclusion: This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize.

Keywords: Belize; Caribbean; cancer; delays; social determinants.

Figure 1.

Map of Belize and its districts. Patients seen in the clinic came from all the districts of Belize, though predominantly from those close to the clinic and with transportation infrastructure. Percentages were as follows: Belize district (44%), Cayo (19%), Orange Walk (14%), Corozal (11%), Stann Creek (8%), and Toledo (5%). Map courtesy of the University of Texas Libraries, The University of Texas at Austin.

Figure 2.

Cancer types seen at KHMH. Here we report the cancer types seen at the clinic. GLOBOCAN’s 2020 report uses neighboring nations to estimate statistics for Belize. In comparison to the GLOBOCAN estimates, the clinic saw more breast patients (28% at the clinic versus 22% based on estimates by GLOBOCAN), less prostate cancer (5% versus 20% estimate), and less liver cancer (<1% versus 8.7% estimate). Other cancers were similar to the estimates in this GLOBOCAN report.

Figure 3.

Time-to-care intervals. Bars indicate time from patient-reported symptom development to a care milestone such as chemotherapy or surgery. This graph includes patients who received treatment at any location (ex. Belize, Mexico, Guatemala). Time of symptom development was patient-reported and consistently recorded by the treating physician (RY) at the initial clinic visit. Surgery following neo-adjuvant chemotherapy is excluded from the above figure. While we have dates for biopsies, surgeries, and chemotherapy, we were unable to identify time from symptom to any medical contact. Patients seeking care had long delays from symptom development till care milestones (oncology clinic visit, biopsy, starting treatment). Future work will explore why these delays occurred. Patients received cancer care expeditiously (<60 days) once seen at the KHMH oncology clinic, showing infrastructure can be developed to deliver timely care.

Figure 4.

Time-to-care for breast cancer patients. Bars indicate time from patient-reported symptom development to a care milestone such as chemotherapy or surgery. This graph includes patients who received treatment at any location (ex. Belize, Mexico, Guatemala). Time of symptom development was patient-reported and consistently recorded by the treating physician (RY) at the initial clinic visit. Surgery following neo-adjuvant chemotherapy is excluded from the above figure. Data on time to first medical contact was not available. While the time to KHMH was long, once seen at the clinic care occurred relatively quickly (<60 days) demonstrating successful infrastructure.