Global Barriers Strain Oncology Nurses in LMICs Care Delivery

Anu Agarwal, vice president of global cancer support at the American Cancer Society, outlined key barriers facing oncology nurses in low- and middle-income countries, emphasizing workforce strain, limited advocacy power and safety concerns.

In many regions, oncology nurses manage extremely high patient-to-nurse ratios compared with the United States, creating significant pressure on care delivery. Agarwal also highlighted hierarchical health care structures that can limit nurses’ ability to advocate for patients. Efforts are underway to flatten these systems and promote more collaborative, team-based care models where nurses have a stronger voice.

Workplace safety remains another major concern. In some settings, chemotherapy is not consistently prepared or administered in safe environments, and access to proper protective equipment may be limited. Addressing these gaps is a priority to better support oncology nurses and improve patient care globally.

Transcript

What are the primary challenges for oncology nurses in low- to middle-income countries?

There are multiple challenges for nurses in low- and middle-income countries. One is the patient-to-nurse ratio, which is incredibly high compared with the United States. Another is the hierarchical structure: nurses want to advocate for patients but do not necessarily have a voice. In many of the settings we work in, we try to reduce that hierarchy and flatten it so health care teams function collaboratively, rather than directives coming only from physicians. Nurses want to advocate, and within health systems, it is important to empower them to do so.

Another major challenge is the work environment, including occupational safety risks. We focus on improving safety with chemotherapy, which is often not prepared or administered in a safe setting, along with a lack of protective equipment. There are many challenges for nurses, for sure.