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

This multi‑country survey evaluated patient‑ and caregiver‑reported barriers to receiving radiotherapy across nine sub‑Saharan African countries (Republic of the Congo, Ethiopia, Gabon, Kenya, Mali, Nigeria, Tanzania, Uganda, Zimbabwe).

Using telephone interviews, 553 randomly selected patients with common solid tumors (breast, cervical, colorectal, prostate), Kaposi sarcoma, and non‑Hodgkin lymphoma diagnosed in 2018–2019 and captured in population‑based cancer registries were assessed for barriers across five dimensions: availability, accessibility, accommodation, affordability, and acceptability. Barriers were recorded regardless of whether patients recalled a radiotherapy recommendation.

Key findings:

• Severe barriers were frequent across all domains, with 21.6% (use of alternative medicine) to 39.6% (cost of treatment) reporting severe problems.
• Cost of treatment was the most commonly cited barrier overall (problematic for 69.0% of patients).
• High levels of reported barriers were particularly noted in patients from Congo, Kenya, Nigeria, and Tanzania.
• Higher education and greater household wealth were generally associated with fewer problems in most categories, but paradoxically with more reported problems related to fear and use of alternative medicine.
• Receipt of radiotherapy was associated with:
  • Fewer problems with transport availability (OR 0.34; 95% CI 0.13–0.88).
  • Fewer problems with trust in healthcare workers (OR 0.44; 95% CI 0.24–0.80).
  • More reported fear (OR 2.33; 95% CI 1.33–4.05).

The authors conclude that while equipment shortages and limited radiotherapy capacity remain critical, they are not the sole barriers. A substantial proportion of patients face severe challenges in multiple dimensions of access. To improve radiotherapy utilization and outcomes, the study highlights the need for interventions targeting affordability, transport and logistical support, improved communication and trust between patients and providers, and enhanced psychosocial support.