Cross-sectional study on the current status of county-level cancer prevention and treatment capabilities in the four southwestern provinces of China.
Authors: Du Chi , Tan Xiang , Xu Jinsong , Cai Haibo , Yan Xu , Li Yanping , Zhang Yan , Lin HuaDe , Liang Yong , Lu Xinan , Wu Mingsong , Yang Kang , Qiu Dong 
Published: August 2024

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Background: Lung cancer (LC) stands out as the most prevalent form of cancer in China, and it is also the primary cause of cancer-related mortality. Notably, 42.3% of newly diagnosed cancer patients are identified at the grassroots level each year. In response, the Chinese government is actively promoting tiered diagnosis and treatment approaches. This study aims to evaluate the current state of county-level cancer prevention and treatment capabilities in China, offering suggestion for policy and the standardized pathway development. Methods: A cross-sectional study was conducted in 470 district and county (city) hospitals across four provinces in southwest China: Sichuan, Yunnan, Guangxi, and Guizhou, from December 2023 to March 2024. The study was initiated by 13 hospitals, and all participating physicians signed informed consent forms. All analyses were conducted by SPSS 22.0. Results: Of the 470 county-level hospitals in China, 151 have a permanent population of over 500,000. 146 counties (198 hospitals) have established cancer specialties. There are 74 medical linear accelerators and 33 cobalt-60 treatment machines. Among them, 63.6% are tertiary hospitals, and 94.9% are public hospitals. 37.4% of hospitals have linear accelerators, and 16.7% have cobalt-60 treatment machines. 89.8% perform TNM staging, 79.1% perform radical surgery, 96.4% perform chemotherapy, 83.2% perform endocrine therapy, 97.5% perform targeted therapy, 87.3% perform immunotherapy, 54.8% perform interventional therapy, and 34.0% perform radiotherapy. Additionally, 56.8% conduct multidisciplinary diagnosis and treatment (MDT), and 37.0% provide palliative care. 83% hospitals have pathology departments, and 46.0% have established cancer centers. 79% hospitals can perform routine pathological diagnosis, and 17.0% can perform genetic testing in-hospital. Imaging departments have conducted CT plain scans in 96.4% of cases, CT enhancements in 87.7%, MRI plain scans in 84.1%, and MRI enhancements in 72.3%. Fibro-bronchoscopy was carried out in 87.2% of cases, and gastrointestinal endoscopy in 84.2%. Morphine injection was accessible in 84.8% of cases, oxycodone in 64.5%, and tramadol in 86.8%. Non-steroidal analgesics were accessible in 88.3% of cases. Conclusions: In the southwestern areas of China, the penetration rate of oncology expertise is 31.1%. Most medical institutions offering oncology specialties are tertiary public hospitals. The average number of radiotherapy machines per county or district is 0.16. The development of surgery, oncology, and the imaging is well. Radiotherapy is still in developing, and the genetic testing capacity in-hospital is insufficient. The application of TNM staging is satisfactory. Accessibility to analgesic and anti-inflammatory drugs is well, but the construction of county cancer centers still needs improvement.