Protocol for a multi-country investigation of overseas care and cancer survivorship in small islands developing states of the Eastern Caribbean: the CaSIDEC study

BackgroundSmall Island Developing States (SIDS) make up worldwide, 65 million people. SIDS have some of the highest rates of cancer mortality burden in the developing world. Disparities in cancer mortality could be attributed to reliance on services overseas which is a common feature across SIDS due to limited resources for comprehensive cancer care on-island. Overseas travel for cancer care, remains largely understudied in SIDS, and epidemiological data on the impact on patient outcomes are lacking. We aim to investigate the association with overseas travel for care and known determinants of patient outcomes (treatment delays, lifestyle and social support) in Caribbean SIDS using mixed-methods. MethodsWe will establish a cohort of 900 cancer survivors residing in the islands of Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia and Saint Vincent. Eligible participants will be adult cancer survivors (any cancer site, histology and diagnosis year) and having accessed health services in their island of residence due to cancer. Sites for recruitment will be cancer support groups, public and private hospitals and oncology clinics. Participants will be contacted by a trained interviewer for a face-to-face survey. For every country visited for diagnosis and/or treatment, we will record the services accessed, and motives for the choice of country. In-depth interviews and focus groups will be conducted with cancer survivors and their caregivers to learn about overseas travel and social support systems. DiscussionThis is the first investigation on the influence of overseas travel on cancer care in multiple Caribbean SIDS. Our work will produce recommendations to fill performance gaps in the systems for cancer care in the OECS that will improve patients lives at multiple phases. It is an important first step to developing data resources for high-quality research in understudied SIDS.