RPD203 - Impact of a Hospital-Based Palliative Care Service on Cancer Patients and Caregivers in Rwanda

Key Message : This first qualitative study of palliative oncology care in Rwanda shows that integrating an inpatient team at a rural cancer center fostered dignity, communication, and trust while reducing stigma for patients and caregivers. Findings identify “kuba hafi” (accompaniment) as a culturally-grounded framework and underscore the importance of expanding access globally.

Abstract:

Background: By 2030, 75% of cancer deaths worldwide are projected to occur in low- and middle-income countries, where most patients present at advanced stages and have limited access to palliative care (PC). In Rwanda, the launch of an inpatient PC team at the rural Butaro Cancer Center of Excellence (BCCOE) represents a key advance and opportunity to understand its impact on patients and caregivers.

Methods: In this qualitative study, we purposively sampled 15 adults with cancer and 15 caregivers, aged ≥18, referred to the inpatient PC consult team at BCCOE from July to August 2025. Semi-structured interviews in Kinyarwanda captured demographic and experiential data, which were transcribed, translated, and thematically analyzed.

Results: Patients’ mean age was 48.4 (±14.2), 66.7% female, 73.3% farmers, 80.0% rural, and 73.3% with primary education or less. Caregivers were frequently children (46.7%), siblings (13.3%), or spouses (13.3%) of patients, with mean age 36.3 (±15.2), 60.0% female, 53.3% farmers, 73.3% rural, and 40.0% primary education or less. Common cancer types were gastric (26.7%), colorectal (20.0%), and breast (20.0%). Majority had metastatic disease (73.3%) and prior cancer-directed therapy (80.0%). Consults focused on pain (100%) and counseling (86.7%).

Preliminary analysis identified several themes: (i) “kuba hafi” (emotional closeness) from the PC team fostered dignity, agency, and resilience even without cure; (ii) effective communication enabled understanding, acceptance, and caregiving; (iii) participants had limited cancer literacy and an unmet desire for home-based PC.

Conclusions: Our preliminary evidence suggests inpatient PC may enhance quality of life, dignity, and psychosocial support for cancer patients and caregivers, while reducing stigma through effective communication and relational trust. This work informed the adoption of “kuba hafi y’umurwayi” – accompaniment and closeness to the patient – as the Kinyarwanda term for PC, and supports expanding PC access, integrating community-based models, and raising public awareness in similar settings.

References: 1. The Lancet, “GLOBOCAN 2018: counting the toll of cancer,” Lancet, vol. 392, no. 10152, p. 985, Sep. 2018, doi: 10.1016/S0140-6736(18)32252-9.
2. “Palliative care.” https://www.who.int/news-room/fact-sheets/detail/palliative-care.
3. Cha J, Isingizwe D, Sebishyimbo F, et al.