Assessing the utilization of cancer medicines in Rwanda: an analysis of treatment patterns

Fidel Rubagumya; Brooke Wilson; Cyprien Shyirambere; Achille Manirakiza; Pacifique Mugenzi; Mary Chamberlin; Wilma M Hopman; Christopher Booth

doi:10.3332/ecancer.2023.1631

Assessing the utilization of cancer medicines in Rwanda: an analysis of treatment patterns

Ecancermedicalscience. 2023 Nov 17:17:1631. doi: 10.3332/ecancer.2023.1631. eCollection 2023.

Authors

Fidel Rubagumya^{1

2

3

4}, Brooke Wilson^{3

4

5}, Cyprien Shyirambere⁶, Achille Manirakiza⁷, Pacifique Mugenzi¹, Mary Chamberlin⁸, Wilma M Hopman⁹, Christopher Booth^{3

4}

Affiliations

¹ Department of Oncology, Rwanda Military Hospital, KK 739 Street, Kicukiro, PO BOX 4016, Kigali, Rwanda.
² Research for Development (RD) Rwanda, Kigali, Rwanda.
³ Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON K7L 3N6, Canada.
⁴ Department of Oncology, Queen's University, Kingston, ON K7L 3N6, Canada.
⁵ School of Public Health, University of New South Wales, Sydney, NSW 2052, Australia.
⁶ Butaro Cancer Center of Excellence, Burera, Rwanda.
⁷ Oncology Unit, Department of Medicine, King Faisal Hospital, PO BOX 2534, Kigali, Rwanda.
⁸ Dartmouth Cancer Center, Lebanon, NH 03755, USA.
⁹ Kingston Health Sciences, Kingston, ON, k7l 2v7, Canada.

Abstract

Introduction: Cancer is a growing public health concern in Africa, especially in low- and middle-income countries (LMICs) like Rwanda. Increased cancer incidences translate into increased utilisation of cancer medicine. Access to affordable cancer medicines in Rwanda is a pressing issue as the National Health Insurance plan does not provide coverage for cancer medicines. In this study, we investigated the utilisation patterns of cancer medicines in Rwanda.

Methods: This retrospective cross-sectional study was conducted at all referral hospitals (n = 3) capable of delivering chemotherapy in Rwanda. The data collection was over a period of 6 months, during which a team of trained research assistants reviewed a convenience sample of selected patient charts. Both paper charts and electronic medical records were used to collect patients' data, including cancer type, stage, treatment setting, type of drugs or regimen used and completed cycles. Data were analysed using descriptive statistics.

Results: A total of 630 patients received chemotherapy during the study period and were included. Seventy-seven percent (n = 486) were female and mean age was 51 (SD ± 13). Among all patients receiving chemotherapy, 43% (n = 270) had breast cancer, 22% (n = 140) had cervical cancer and 19% (n = 121) had colorectal cancer. The majority of patients (71%) had a community-based insurance. Butaro Cancer Centre treated the most patients (48%, n = 303). Thirty-six percent (221/630) had stage III cancer. The most common regimens within the cohort were adriamycin, cyclophosphamide and taxane, capecitabine and oxaliplatin (CAPOX), paclitaxel + carboplatin and a single agent cisplatin given concurrently with radiotherapy. The proportion of chemotherapy that was given in the curative and palliative setting was 72% and 28% respectively.

Conclusion: Access to affordable cancer medicines remains a challenge in Rwanda. The study's findings provide valuable information on the utilisation patterns of cancer medicines in Rwanda, which can be used to guide policy decisions and improve cancer care in the country.

Keywords: LMICs; Rwanda; cancer; chemotherapy; utilisation.