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The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility

Bhangdia, Kayleigh ; Natarajan, Abirami ; Rudolfson, Niclas LU ; Verguet, Stéphane ; Castro, Marcia C. ; Dusengimana, Jean Marie Vianney ; Shyirambere, Cyprien ; Schleimer, Lauren E. ; Shulman, Lawrence N. and Umwizerwa, Aline , et al. (2025) In BMC Cancer 25(1).
Abstract

Background: Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda’s rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion. Methods: We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012–2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to... (More)

Background: Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda’s rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion. Methods: We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012–2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to examine the association of distance and other patient characteristics with late-stage diagnoses and treatment completion within one year of diagnosis. Results: The analytic cohort for stage included 426 patients; 75.1% had late-stage (stage 3 or 4) disease. In univariable analyses, patients residing in BCCOE’s surrounding district had a lower proportion of late-stage diagnoses compared to those residing outside the district (57.9% v 76.8%, p = 0.02). In adjusted analyses, odds of late-stage diagnosis were 2.46 (95% CI:1.21–5.12) times higher among those in distance quartile 4 (> 135.8 km) versus 1 (< 55.7 km); the effect of distance was less strong in sensitivity analyses excluding patients from BCCOE’s surrounding district. Patients from sectors with > 50% poverty had 2.33 times higher odds of late-stage diagnoses (95% CI:1.07–5.26) relative to those with poverty < 30%. In the treatment completion cohort (n = 348), 49.1% of patients completed surgery and chemotherapy within a year. In adjusted analyses, travel distance and poverty were not linearly associated with treatment completion. Conclusions: At Rwanda’s first public cancer facility, sector-level poverty and longer travel distances were associated with late-stage breast cancer diagnoses, but less clearly associated with treatment completion, perhaps partly due to travel stipends provided to the lowest-income individuals undergoing treatment. Our findings support further investigation into wider use of travel stipends to facilitate early diagnosis and treatment completion.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Africa, Breast cancer, Cancer stage, Disparities, Distance, Global cancer, Outcomes, Rwanda, Travel
in
BMC Cancer
volume
25
issue
1
article number
146
publisher
BioMed Central (BMC)
external identifiers
  • pmid:39865262
  • scopus:85217130185
ISSN
1471-2407
DOI
10.1186/s12885-025-13489-2
language
English
LU publication?
yes
id
928b9cc5-f275-4ad0-90f1-d2aa39642b41
date added to LUP
2025-04-07 12:19:58
date last changed
2025-05-05 13:11:23
@article{928b9cc5-f275-4ad0-90f1-d2aa39642b41,
  abstract     = {{<p>Background: Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda’s rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion. Methods: We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012–2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to examine the association of distance and other patient characteristics with late-stage diagnoses and treatment completion within one year of diagnosis. Results: The analytic cohort for stage included 426 patients; 75.1% had late-stage (stage 3 or 4) disease. In univariable analyses, patients residing in BCCOE’s surrounding district had a lower proportion of late-stage diagnoses compared to those residing outside the district (57.9% v 76.8%, p = 0.02). In adjusted analyses, odds of late-stage diagnosis were 2.46 (95% CI:1.21–5.12) times higher among those in distance quartile 4 (&gt; 135.8 km) versus 1 (&lt; 55.7 km); the effect of distance was less strong in sensitivity analyses excluding patients from BCCOE’s surrounding district. Patients from sectors with &gt; 50% poverty had 2.33 times higher odds of late-stage diagnoses (95% CI:1.07–5.26) relative to those with poverty &lt; 30%. In the treatment completion cohort (n = 348), 49.1% of patients completed surgery and chemotherapy within a year. In adjusted analyses, travel distance and poverty were not linearly associated with treatment completion. Conclusions: At Rwanda’s first public cancer facility, sector-level poverty and longer travel distances were associated with late-stage breast cancer diagnoses, but less clearly associated with treatment completion, perhaps partly due to travel stipends provided to the lowest-income individuals undergoing treatment. Our findings support further investigation into wider use of travel stipends to facilitate early diagnosis and treatment completion.</p>}},
  author       = {{Bhangdia, Kayleigh and Natarajan, Abirami and Rudolfson, Niclas and Verguet, Stéphane and Castro, Marcia C. and Dusengimana, Jean Marie Vianney and Shyirambere, Cyprien and Schleimer, Lauren E. and Shulman, Lawrence N. and Umwizerwa, Aline and Kigonya, Catherine and Butonzi, John and MacDuffie, Emily and Fadelu, Temidayo and O’Neil, Daniel S. and Nguyen, Cam and Mpunga, Tharcisse and Keating, Nancy L. and Pace, Lydia E.}},
  issn         = {{1471-2407}},
  keywords     = {{Africa; Breast cancer; Cancer stage; Disparities; Distance; Global cancer; Outcomes; Rwanda; Travel}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Cancer}},
  title        = {{The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility}},
  url          = {{http://dx.doi.org/10.1186/s12885-025-13489-2}},
  doi          = {{10.1186/s12885-025-13489-2}},
  volume       = {{25}},
  year         = {{2025}},
}