Fidel Rubagumya

Financial Toxicity: Unveiling the Burden of Cancer Care on Patients in Rwanda

Abstract Introduction Cancer is a major public health problem in Rwanda and other low- and middle-income countries (LMICs). While there have been some improvements in access to cancer treatment, the cost of care has increased, leading to financial toxicity and treatment barriers for many patients. This study explores the financial toxicity of cancer care in Rwanda. Methods This prospective cross-sectional study was conducted at 3 referral hospitals in Rwanda, which deliver most of the country’s cancer care. Data were collected over 6 months from June 1 to December 1, 2022 by trained research assistants (RAs) using a modified validated data collection tool. RAs interviewed consecutive eligible patients with breast cancer, cervical cancer, colorectal cancer, Hodgkin’s and non-Hodgkin’s lymphoma who were on active systemic therapy. The study aimed to identify sources of financial burden. Data were analyzed using descriptive statistics. Results 239 patients were included; 75% (n = 180/239) were female and mean age was 51 years. Breast, cervix, and colorectal cancers were the most common diagnoses (42%, 100/239; 24%, 58/239; and 24%, 57/239, respectively) and 54% (n = 129/239) were diagnosed with advanced stage (stages III-IV). Financial burden was high; 44% (n = 106/239) of respondents sold property, 29% (n = 70/239) asked for charity from public, family, or friends, and 16% (n = 37/239) took loans with interest to fund cancer treatment. Conclusion Despite health insurance which covers many elements of cancer care, a substantial proportion of patients on anti-cancer treatment in Rwanda experience major financial toxicity. Novel health financing solutions are needed to ensure accessible and affordable cancer care.

Treatment response after chemoradiation with an external beam radiation therapy boost in cervical cancer patients in Rwanda

Abstract Background Cervical cancer remains a significant public health burden in Rwanda, where brachytherapy is not widely available. This study assessed treatment response in cervical cancer patients post-chemoradiation using magnetic resonance imaging (MRI)-based Response Evaluation Criteria in Solid Tumors (RECIST), focusing on the effectiveness of external beam boost as an alternative. Patients and Methods This retrospective study was conducted at the Rwanda Cancer Centre, including patients treated with chemoradiation followed by an external beam boost from January 2020 to June 2022. MRI scans performed before treatment and 3-6 months post-treatment were analyzed using RECIST criteria to classify treatment response as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Agreement between clinical and MRI staging pre- and post-treatment was assessed using kappa coefficients. Results Eighty-eight patients were included (mean age: 57.7 ± 10.6 years). CR, PR, SD, and PD were observed in 67%, 17%, 9%, and 7% of patients, respectively. MRI findings demonstrated substantial agreement with clinical staging before pre-treatment (78%, K = 0.63) and after post-treatment (71%, K = 0.71). CR rates were highest in early-stage disease (FIGO stage I: 90%), whereas PD was more frequent in advanced stages (FIGO stage II: 9%; FIGO stage III: 13%). Conclusion The MRI-based RECIST criteria effectively assess the cervical cancer treatment response after post-chemoradiation. The high CR rate (67%) suggests that an external beam boost may serve as a viable alternative for brachytherapy. However, PD in advanced-stage disease highlights the need for further research to optimize treatment strategies. Future studies should evaluate long-term outcomes and explore advanced MRI techniques to enhance the response assessment.