Decentralizing Post-Treatment Follow-Up for Cervical Cancer in Rwanda: Perspectives of Survivors and Clinicians

Cervical cancer incidence is increasing in Rwanda, leading to a growing population of survivors requiring long-term follow-up. The current oncologist-led survivorship model is not sustainable, given the limited oncology workforce and persistent geographic and financial barriers to specialist care. This study explored survivors' and clinicians' perspectives on decentralizing post-treatment cervical cancer follow-up to district hospitals.

We conducted semistructured, in-depth interviews with 33 cervical cancer survivors, six oncologists at the Rwanda Cancer Center, and four gynecologists practicing at hospitals. Interviews were audiorecorded, translated, and transcribed verbatim. Data were analyzed using NVivo software using an iterative thematic approach combining inductive and deductive analyses.

Cervical cancer survivors valued frequent follow-up and ongoing surveillance, largely driven by fear of cancer recurrence and uncertainty regarding late treatment effects. Strong trust in oncologists and established survivor-clinician relationships motivated continued follow-up at the cancer center for some participants. Others supported district hospital-based follow-up, citing reduced travel distance, lower financial burden, and improved accessibility, particularly during emergencies. However, limited confidence in district-level cancer expertise and diagnostic capacity emerged as major concerns. Clinicians acknowledged the feasibility of district-based survivorship care for stable patients but emphasized the need for structured training, standardized follow-up protocols, and clear referral pathways to ensure patient safety and care quality.

Cervical cancer survivors and clinicians in Rwanda hold nuanced perspectives on decentralizing cervical cancer survivorship care. Although decentralization is viewed as necessary to improve access and system sustainability, successful implementation will require shared-care models, clinician training, and strong linkages between district hospitals and cancer centers.