Patient‐ and caregiver‐reported barriers to radiotherapy for cancer in sub‐Saharan Africa—A survey of population‐based registries

Abstract

Although radiotherapy is an essential part of comprehensive cancer care, access is heavily limited in most sub-Saharan African (SSA) countries. Patients' barriers to care can be grouped as availability, accessibility, accommodation, affordability, and acceptability. We aimed to assess cancer patient- and caregiver-reported barriers in nine SSAn countries (Republic of the Congo, Ethiopia, Gabon, Kenya, Mali, Nigeria, Tanzania, Uganda, and Zimbabwe). We conducted a telephone-based survey among 553 randomly selected patients with breast, cervical, colorectal, and prostate cancer, Kaposi sarcoma and non-Hodgkin lymphoma diagnosed between 2018 and 2019 registered in population-based registries of the African Cancer Registry Network. We inquired about receipt of radiotherapy and barriers irrespective of recalling a recommendation. Among all categories, 21.6% (Use of alternative medicine) to 39.6% (Cost of treatment) of patients reported severe barriers. Most common was problematic Cost of treatment (69.0% overall). A high share of patients from Congo, Kenya, Nigeria, and Tanzania reported barriers. Higher education and wealth were associated with reduced problems in all categories except increased problems with Fear and Use of alternative medicine. Receipt of radiotherapy was associated with fewer problems with Availability of transport (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.13-0.88) and Trust in healthcare workers (OR: 0.44; 95% CI, 0.24-0.8), and increased Fear (OR: 2.33; 95% CI, 1.33-4.05). Seeing that one-third of the patients reported severe problems in all dimensions, shortage of radiotherapy units is not the only problematic aspect of access to radiotherapy. Improvements in affordability, patient-healthcare worker communication, and psychosocial support are needed.