Unmet palliative care needs and determinants among women with breast and cervical cancer and their caregivers in Ethiopia

Abstract

Introduction: Breast and cervical cancers are the leading causes of cancer related morbidity and mortality among Ethiopian women. These cancers carry burdens including impacts on femininity, marital relationships, and family stability. Yet palliative care (PC) remains under addressed. Objective: This study assessed unmet PC needs and determinants among women with breast and cervical cancer and caregiver burden in Ethiopia. Methods: Institution based cross sectional study was conducted from February to April, 2025 at Tikur Anbessa Specialized Hospital, and Hawassa University Comprehensive Specialized Hospital, Ethiopia. Using systematic random sampling, 480 patients and 458 caregivers were enrolled. Data were collected using Supportive and Palliative Care Indicators Tool for Low Income Settings, African Palliative Care Association tool, and the three item Oslo Social Support Scale. Multivariable logistic regression identified factors associated with higher PC needs. Statistical significance set at p ≤ 0.05. Results: . 66.5%, p = 0.03). Patients in Sidama had higher unmet needs (74.6%) than in Addis Ababa (51.5%, p = 0.001). Among cervical cancer patients, chemotherapy receipt was the predictor (AOR = 4.21, 95% CI: 2.18-8.13); among breast cancer patients, late stage diagnosis was associated (AOR = 2.84, 95% CI: 1.52-5.31). Difficulty accessing hospitals (AOR = 1.89, 95% CI: 1.02-3.66), preference for local PC (AOR = 2.65, 95% CI: 1.15-6.10), and Muslim religious affiliation for cervical cancer (AOR = 2.35, 95% CI: 1.02-5.41) and breast cancer (AOR = 2.18, 95% CI: 1.01-4.70) were linked to higher PC needs. Social support was protective (AOR = 0.30). 75.5% caregiver reported high emotional strain and 59.8% high financial burden. Conclusion: Psychosocial distress was the most common need requiring comprehensive PC service. Given the protective role of social support and patient preference for local care, community based PC models should be integrated into primary health systems. The caregiver burden demands investment in caregiver support programs.