Cancer Treatment Abandonment in Africa: A Narrative Review of Socioeconomic Determinants, Clinical Consequences and Strategies for Improving Treatment Completion

Abstract

Context: Across Africa, patients with potentially curable cancers may fail to initiate or complete recommended curative treatment. This preventable phenomenon, known as treatment abandonment, occurs amid limited diagnostic capacity, workforce shortages, and substantial financial and geographical barriers to care, highlighting the need for an integrated synthesis of its magnitude, determinants, consequences and potential remedies. This narrative review therefore examined the magnitude and patterns of cancer treatment abandonment in Africa, identified its socioeconomic and related determinants, evaluated its clinical consequences, and critically examined strategies for improving treatment completion.

Materials and Methods: Peer-reviewed literature was identified through searches of PubMed/MEDLINE, Scopus and CINAHL, supplemented by reference-list screening, with 53 publications meeting the eligibility criteria and included in the narrative synthesis. Narrative synthesis accommodated the substantial heterogeneity in populations, cancer types, study designs and outcome definitions across the included evidence.

Results: Reported abandonment varied substantially across settings and observation periods, reaching 54% in paediatric cohorts and approximately one-fifth among adults initiating chemotherapy. Financial hardship, compounded by transport costs, distance from treatment centres and inadequate health-insurance coverage, was the most consistently reported determinant, alongside health-system, sociocultural and psychosocial barriers. These patterns carried real clinical weight: abandonment was strongly associated with reduced event-free survival and premature mortality, and it complicated the interpretation of survival statistics whenever patients lost to follow-up were censored rather than treated as an adverse outcome. Encouragingly, multicomponent interventions combining financial assistance, transport reimbursement, residential accommodation, patient navigation and active follow-up substantially reduced abandonment where they were evaluated, although navigation alone could not overcome unaffordable treatment.

Conclusion: Cancer treatment abandonment in Africa is therefore best understood as a structural and largely preventable outcome rather than being attributed primarily to a failure of patient motivation. Reversing it will require financial protection integrated into routine cancer services, expanded health-insurance coverage, decentralised care, standardised definitions and reporting, and reliable patient-tracking systems, supported by further prospective research, particularly among adult populations.