Access and time to chemotherapy among Ethiopian cancer patients: a population-based registry study

Chemotherapy is an essential component of comprehensive cancer care and timely access can improve survival outcomes. The objective of this study was to assess the time to chemotherapy initiation and patient-reported barriers to cancer care among patients from Addis Ababa, Ethiopia.

We conducted a retrospective study using a randomly selected sample of 350 patients with common cancers (breast [ICD-10: C50], cervical [C53], colorectal [C18-20], esophageal [C15], gastric [C16], and ovarian [C56]) registered at the population-based Addis Ababa City Cancer Registry in 2021. Patients or their relatives were followed-up via questionnaire-based telephone interview and treatment data were extracted from their medical records. The time from pathological diagnosis to initiation of chemotherapy (time to treatment) was calculated. Regression analyses were conducted to identify predictors of chemotherapy initiation and treatment delays.

Most patients (71.7%) received chemotherapy and the median time to treatment was 63 days (IQR 36.5-128 days). Patients reported considerable barriers to treatment regarding fear, cost and waiting times. Having health insurance (OR 2.70; 95% CI, 1.33-5.50) and trust in healthcare professionals (OR 1.76; 95% CI, 1.16-2.68) were associated with higher odds of receiving chemotherapy. Patients with cervical (OR 0.07; 95% CI, 0.03-0.18), gastric (OR 0.21; 95% CI, 0.05-0.86) or esophageal cancer (OR 0.10; 95% CI, 0.02-0.53) were less likely to initiate chemotherapy compared to breast cancer patients. Longer time to treatment was not associated with any of the assessed characteristics or perceived barriers.

Over half of the cancer patients from Addis Ababa wait more than 2 months to initiate chemotherapy after a pathological diagnosis. Expanding oncology services and health insurance coverage could enhance access to treatment. Health professionals should promote patient trust by appropriately addressing their psychosocial needs, including cancer-related fear, to improve the uptake of treatment and thus clinical outcomes.