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Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023 Feb;9:e2200218



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85148255029 (requires institutional sign-in at Scopus site)


PURPOSE: To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes.

METHODS: A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria.

RESULTS: A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life.

CONCLUSION: Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

Author List

Beltrán Ponce SE, Abunike SA, Bikomeye JC, Sieracki R, Niyonzima N, Mulamira P, Kibudde S, Ortiz de Choudens S, Siker M, Small C, Beyer KMM


Kirsten M. Beyer PhD, MPH Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Saryleine Ortiz De Choudens MD Instructor in the Radiation Oncology department at Medical College of Wisconsin
Malika L. Siker MD Associate Dean, Associate Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Africa South of the Sahara
Breast Neoplasms
Health Services Accessibility
Quality of Life
Uterine Cervical Neoplasms