The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility
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 advan...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12885-025-13489-2 |
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| author | Kayleigh Bhangdia Abirami Natarajan Niclas Rudolfson Stéphane Verguet Marcia C. Castro Jean-Marie Vianney Dusengimana Cyprien Shyirambere Lauren E. Schleimer Lawrence N. Shulman Aline Umwizerwa Catherine Kigonya John Butonzi Emily MacDuffie Temidayo Fadelu Daniel S. O’Neil Cam Nguyen Tharcisse Mpunga Nancy L. Keating Lydia E. Pace |
| author_facet | Kayleigh Bhangdia Abirami Natarajan Niclas Rudolfson Stéphane Verguet Marcia C. Castro Jean-Marie Vianney Dusengimana Cyprien Shyirambere Lauren E. Schleimer Lawrence N. Shulman Aline Umwizerwa Catherine Kigonya John Butonzi Emily MacDuffie Temidayo Fadelu Daniel S. O’Neil Cam Nguyen Tharcisse Mpunga Nancy L. Keating Lydia E. Pace |
| author_sort | Kayleigh Bhangdia |
| collection | DOAJ |
| description | 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 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. |
| format | Article |
| id | doaj-art-44abcb4cf87c45df93dc31c6c8510dbe |
| institution | Kabale University |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Cancer |
| spelling | doaj-art-44abcb4cf87c45df93dc31c6c8510dbe2025-02-02T12:28:57ZengBMCBMC Cancer1471-24072025-01-0125111110.1186/s12885-025-13489-2The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facilityKayleigh Bhangdia0Abirami Natarajan1Niclas Rudolfson2Stéphane Verguet3Marcia C. Castro4Jean-Marie Vianney Dusengimana5Cyprien Shyirambere6Lauren E. Schleimer7Lawrence N. Shulman8Aline Umwizerwa9Catherine Kigonya10John Butonzi11Emily MacDuffie12Temidayo Fadelu13Daniel S. O’Neil14Cam Nguyen15Tharcisse Mpunga16Nancy L. Keating17Lydia E. Pace18Institute for Health Metrics and EvaluationDana-Farber Cancer InstituteLund UniversityDepartment of Global Health and Population, Harvard T. H. Chan School of Public HealthDepartment of Global Health and Population, Harvard T. H. Chan School of Public HealthPartners in Health Rwanda/Inshuti Mu BuzimaPartners in Health Rwanda/Inshuti Mu BuzimaDepartment of Surgery, Columbia University Medical CenterAbramson Cancer Center, University of PennsylvaniaPartners in Health Rwanda/Inshuti Mu BuzimaPartners in Health Rwanda/Inshuti Mu BuzimaMinistry of HealthAbramson Cancer Center, University of PennsylvaniaDana-Farber Cancer InstituteDepartment of Internal Medicine & Yale Cancer Center, Yale University School of MedicineUniversity of Colorado Anschutz Medical CampusUniversity Teaching Hospital of KigaliBrigham and Women’s HospitalBrigham and Women’s HospitalAbstract 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.https://doi.org/10.1186/s12885-025-13489-2Breast cancerDistanceTravelGlobal cancerRwandaAfrica |
| spellingShingle | Kayleigh Bhangdia Abirami Natarajan Niclas Rudolfson Stéphane Verguet Marcia C. Castro Jean-Marie Vianney Dusengimana Cyprien Shyirambere Lauren E. Schleimer Lawrence N. Shulman Aline Umwizerwa Catherine Kigonya John Butonzi Emily MacDuffie Temidayo Fadelu Daniel S. O’Neil Cam Nguyen Tharcisse Mpunga Nancy L. Keating Lydia E. Pace The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility BMC Cancer Breast cancer Distance Travel Global cancer Rwanda Africa |
| 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 |
| title_full | The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility |
| title_fullStr | The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility |
| title_full_unstemmed | The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility |
| title_short | The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility |
| title_sort | association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural rwandan cancer facility |
| topic | Breast cancer Distance Travel Global cancer Rwanda Africa |
| url | https://doi.org/10.1186/s12885-025-13489-2 |
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