Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study

Abstract

Introduction: Cancer represents a growing public health concern. Late-stage at diagnosis, limited access to effective treatment, and loss to follow-up are responsible for dismal outcomes.
 Objective: To describe care pathways, turnaround times, and identify barriers to timely initiation of cancer treatment
 Methods: Using a sequential mixed-methods design involving focus group discussions, we followed up 50 participants between January, and June 2018. We computed the median observed turnaround time to treatment (TTT) at each care step and reported delay as deviations from the proposed ideal turnaround times.
 Results: The ideal TTT with either chemotherapy, or radiotherapy, or surgery was 8, 14, and 21 days respectively. At a median follow-up time of 35.5 days (IQR 17-66), only 29 of the 50 study participants had completed all steps between registration and initiation of treatment, and the observed median TTT was 16 days (9 – 22 days) for chemotherapy, and 30 days (17 – 49 days) for radiotherapy, reflecting a significant delay (p-value = 0.017). Reported barriers were; shortage ofspecialists, patients required visits to outside facilities for staging investigations, prohibitive costs, poor navigation system and time wastage.
 Conclusions: When compared to the recommended ideal turnaround time, there was significant institutional delay in access to chemotherapy and radiotherapy attributed to multiple external and internal healthcare system barriers.
 Keywords: Turnaround time; steps; barriers; waiting time; cancer; Uganda.

Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review

“…The present ndings relate to those published by authors in Zimbabwe's Parirenyatwa hospital where radiotherapy uptake was reported in about 86% of the patients, with only 38% administered with chemotherapy [13]. In both settings, similar health system constraints are reported [13,14,24]. In another study done in India, treatment completion rates for EBRT and Brachytherapy were also found to be low (39%) [23].…”

“…This level of adherence is low when compared to that reported in previous studies in similar settings [15,16] and to the adherence rates reported in a systematic review done elsewhere of 42-54% [7]. Recent studies done in Uganda have attributed delays in the initiation and continuation of cancer treatment to the poor socio-economic status of the patients, inadequate infrastructure for cancer care, and ine ciencies in the health care system [14,24]. Also notably, this study was carried during November 2020 to May 2021, when the nation was on the road to recovery from the COVID − 19 pandemic.…”

“…However, the bene cial effects of chemoradiation therapy can only be realized if patients adhere to treatment [8]. Good compliance or adherence implies that the patient follows recommendations by the treatment provider on timing, dosage, and frequency of medication [9], however, this remains a signi cant challenge for many people living with cancer in resourcelimited settings [10][11][12][13][14]. Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [13,15,16], with patient loss to follow-up of up to 15% or greater [17,18].…”

Impact of different post-operative treatment modalities on long-term outcomes in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIICp cervical cancer

“…There has been consensus that a time gap, usually within 6 weeks between surgery and initiation of radiotherapy, was related to better survival 26 27. Nevertheless, in low-income countries where the incidence of cervical cancer is high,28 the waiting period for oncologic treatment is generally much longer 29 30. Sequential chemoradiation could be an alternative that reduces the time gap as chemotherapy can be administered while waiting for radiation, especially when resources are limited.…”

The economic burden of cervical cancer on women in Uganda: a cross-sectional study

“…Of the literature available, a large portion, including that specific to cervical cancer, is qualitative in design. [9][10][11] In 2022, Germans et al published a qualitative study on the socio-economic burden of cervical cancer on women in Uganda which largely focused on the financial burden. They found that a cervical cancer diagnosis leads to economic disruptions and can further exasperate a family's financial security.…”