Barriers to access of hematopoietic stem cell transplantation

an integrative review

Abstract

Introduction: Hematopoietic stem cell transplantation is a therapy for which even countries with universal health systems face challenges to ensure its access to the population. Barriers to access can be characterized as geographic, organizational, socioeconomic and of information. Objective: To conduct an integrative review of barriers to access of hematopoietic stem cell transplantation. Methods: Databases chosen were BVS, PubMed and Scopus. Population and phenomenon were established, respectively as “hematopoietic stem cell transplantation” and “barriers to access” with descriptors in Portuguese and English. 22 articles, published between 2012 and 2022, were selected. Results: Access was hampered by the distance to transplant center, in more populous regions, with high demand for services and transportation difficulties. There was better access in countries with higher GDP per capita, more installed transplant centers and for the population with higher income. Insurance coverage, support by public policies, assistance in academic centers, organized regulation and prioritization of emergencies facilitated access. The understanding of the diseases, the adherence to the treatments, the perception of survival by the patients and the skills of the professionals improved the access. Conclusion: All categories of access barriers were addressed, with multifactorial and interrelated origins, with the vulnerable population being the most affected.