Background:
Crises such as the COVID-19 pandemic, climate-related disasters, and political or financial shocks have exposed profound vulnerabilities in health systems worldwide, with particularly severe consequences for cancer control in low- and middle-income countries (LMICs). Disruptions across prevention, early detection, diagnosis, treatment, and palliative care threaten to reverse gains in cancer outcomes and widen inequities. Although resilience (the capacity of health systems to anticipate, absorb, adapt to, recover and learn from shocks) has become a central policy objective, empirical evidence on how LMIC health systems coordinate cancer control during crises, and which mechanisms meaningfully support resilience, remains limited.
Objectives:
This study examines how different types of crises affect coordination across the cancer control continuum in LMICs and identifies system-level factors that enable or constrain resilient responses, with the aim of generating context-sensitive, policy-relevant recommendations.
Methods:
We employed a two-phase qualitative design. Phase 1 comprised a scoping review to contextualise disruptions and mitigation strategies during COVID-19 and other major crises. Phase 2 is an ongoing multiple–case study across six LMICs—Brazil, India, Morocco, South Africa, Turkey, and Uganda. To date, 38 semi-structured interviews have been conducted with policymakers, health professionals, cancer service providers, civil society representatives, and people with lived experience of cancer, purposively sampled across the cancer continuum. Data were analysed thematically, supported by framework analysis, to identify cross-cutting patterns, contextual differences, and system-level enablers and constraints of resilience.
Results:
Preliminary analysis revealed substantial disruption across the cancer continuum. Consistent with the scoping review, participants reported delayed diagnoses, treatment interruptions, and service backlogs, with downstream consequences for stage at presentation and continuity of care. Health services demonstrated adaptive resilience through reconfigured patient flows, prioritisation protocols, substitution of treatment modalities, and expanded use of telemedicine. However, adaptation was largely driven by professional solidarity, local leadership, and institutional learning, rather than formal preparedness mechanisms.
Civil society organisations and family networks emerged as critical enablers of continuity, supporting transportation, medication access, patient navigation, and mental health, yet systematic mechanisms to incorporate community perspectives into crisis decision-making were absent. Structural vulnerabilities (including under-prioritisation of cancer in health policy, chronic underfunding, fragmented governance, weak information systems, rigid procurement processes, and political polarisation) severely constrained resilience. Analysis of recent floods in Brazil further highlighted the consequences of climate-related crises, including infrastructure damage, service displacement, workforce disruption, and reliance on emergency transfers, with cancer care largely absent from formal disaster planning.
Conclusions
While LMIC health systems can mobilise adaptive responses to sustain cancer services during crises, these remain predominantly reactive and structurally constrained. Strengthening resilience requires formal integration of cancer services into emergency preparedness, institutionalised community engagement, and sustained investment to address long-standing governance, financing, and information system weaknesses. Embedding cancer control within broader health security, climate resilience, and equity agendas is essential to safeguard continuity of care and mitigate the long-term impact of crises on cancer outcomes.