Radiotherapy Prioritization Patterns and Outcomes at a Referral Program in Rwanda

Abstract

Purpose: Low- and middle-income countries (LMICs) are disproportionally burdened by cancer. Although it is estimated that half of all cancer patients would benefit from radiotherapy (RT), there is currently limited access to RT in Rwanda. For patients seen at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first national cancer referral center, there is funding for ten patients every six weeks to be sent to Nairobi Hospital in Kenya for RT treatment. In 2016, new RT guidelines that prioritized chance of cure were implemented at BCCOE. In this study, we analyzed the characteristics of patients sent to Nairobi for RT to 1) evaluate translation of these guidelines into clinical practice, and 2) assess clinical outcomes that may instruct future resource allocation and patient prioritization decision-making. Methods: We performed a retrospective chart review of all cancer patients seen at BCCOE between 4/2016 and 3/2018 who subsequently underwent RT treatment in Nairobi. We collected patient demographic information, pathologic diagnoses, staging information, chemotherapy and RT treatment information, adverse events, post RT follow-up information, and status at the time of last follow-up. Results: We identified 154 patients who received RT during the study period: the median age was 48 years (interquartile range [IQR], 39-56 years) and 132 (85.7%) were female. 114 (74%) patients had cervical cancer, 14 (9.1%) had head and neck cancer, 10 (6.5%) had rectal cancer, 7 (4.6%) had Wilms tumor, 6 (3.9%) had soft tissue sarcoma, and 3 (2%) had another solid tumor type. At the time of data extraction, 78 (50.7%) patients were alive without evidence of recurrence, 3 (2%) were alive with evidence of recurrence, 33 (21.4%) were deceased, and 26(16.9%) were lost to follow-up. The median follow-up was 20.4 months (IQR, 13.6-27.6 months). 123 (80.9%) of patients were alive 12 months post-diagnosis. Conclusion: This study demonstrates the successful implementation of an effective prioritization guideline system in Sub-Saharan Africa. Further comparison of patients sent for RT versus those in whom RT was indicated but not provided as well as qualitative data on patient experiences will further clarify the optimal way to allocate this scarce resource.