The economic burden of cervical cancer on women in Uganda: a cross-sectional study

PURPOSE There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda, including the burden of out-of-pocket costs. This is important to understand because, in addition to being economic providers, women are primary caregivers. The objective of this analysis is to describe the economic impact of cervical cancer treatment, including how this differs by socio-economic status (SES) in Uganda. METHODS We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible for this study if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a 45-minute survey which included questions about their out-of-pocket costs, unpaid labor, and changes in their family’s economic situation. A wealth index was constructed from the participants ownership of household items to determine their SES. Descriptive statistics were reported. RESULTS Of the 338 participants who completed the survey, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Both groups of women reported paying out-of-pocket for cervical cancer care (higher SES 95.5%, lower SES 92.3%). Only 15/338 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (p-value=0.004) and selling possessions to pay for cancer care (p-value=0.006). With regards to unpaid labor, women from both groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis. CONCLUSION Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further financial support could help alleviate the financial burden of cervical cancer of care on women and families in Uganda. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Ms. Hallie Dau received Canada Graduate Doctoral Award from the Canadian Institutes of Health Research. This study funding is provided by the Canadian Institutes of Health Research ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics for this study was approved by the University of British Columbia Behavioral Research Ethics Board (H17-02435), Uganda Cancer Institute Research and Ethics Committee (UCI-2022-39), and the Uganda National Council of Science and Technology Research Ethics Committee (HS2420ES). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data cannot be shared publicly due to ethical restrictions, as participants did not provide consent at the time of data collection for data to be shared publicly. Anonymized minimal data set will be made available by request for researchers who meet the criteria for access to confidential data and approval by the UBC Research Ethics Board (contact via cwreb{at}bcchr.ubc.ca)