Radiotherapy Access and Treatment in Rwanda: Demographics and Clinical Characteristics of Cervical Cancer Patients

Abstract

Nearly all cervical cancer deaths occur in low- and middle-income countries (LMIC), and in Rwanda, cervical cancer is the leading cause of cancer mortality among women. In 2018, Rwanda Cancer Center (RCC) opened as the first place to offer radiotherapy (RT) for cervical cancer treatment in the country. This study aims to characterize patient demographic and clinical characteristics, access to care, and predictors associated with treatment initiation. This study was conducted at RCC in Kigali. Between 2019 and 2022, patients who received radiotherapy were included; data were extracted from electronic medical records, including demographics, medical history, cancer information, pre-RT imaging, RT information, and toxicities. Descriptive statistics were used to summarize patient characteristics; chi-square and t-tests were used to test any distribution differences. Time to treatment initiation (TTI, time from biopsy to first RT session) was dichotomized as ≤45 vs. >45 days) and multivariable logistic regression was used to find predictors of TTI. Of the 620 women who presented with cervical cancer, 428 (69%) were treated with radiotherapy (External Beam Radiotherapy using Volumetric Modulated Arc Therapy). The average patient's age was 55.4 years (+/-11.4), and the median distance traveled was 87.7 km (IQR: 37.0-140.0). Nearly 88% used community-based (government) insurance (CBHI, either 0% and 10% copay category); 21.9% were known to be living with HIV. 66.9% of patients presented with stage 3 or 4 disease. Of the patients receiving RT, 357 (83%) received chemotherapy. Predictors of TTI (≤45 days) were travel distance and insurance type. The odds of early TTI (≤45 days) decreased by 27% per 1 log kilometer increase. Patients using CBHI insurance had 54% lesser odds of early TTI than others. RCC has built a capacity to provide advanced radiation treatment to cancer patients in Rwanda and surrounding LMIC countries. Despite the COVID-19 pandemic, RCC has treated nearly 500 patients already. This study is the first to document these patient characteristics; results suggest that longer travel distance and public insurance are major factors for longer treatment initiation. Strategies to identify barriers to screening for early cancer detection and expediting treatment initiation are ongoing.