Teleoncology Implementation in a Low-Resource Setting: A Retrospective Cohort Study From Lubango, Angola

Background: We evaluated whether structured teleoncology could support the safe and affordable delivery of systemic oncology treatment at a provincial Angolan hospital without such installed capacity previously. Methods: Retrospective cohort study at Lubango Central Hospital (HCL), Angola, as a proof of principle, September 2024–May 2025. The initial analysis covered 85 patients discussed at a multidisciplinary tumor board (MTB) by videoconference; a second analysis assessed safety, outcomes, and costs in 23 patients treated at HCL. Efficacy was judged against palliative-intent indicators. Results: In a cohort presenting overwhelmingly with advanced disease (87.0% stage III–IV), 93 cycles were delivered under remote supervision with no preparation errors, no contamination, no grade 4–5 adverse events (95% confidence interval 0–4.0%), no toxicity admissions, and no treatment-related deaths. Course completion reached 89.5%. The MTB processed 156 consultations and met all technical and operational targets; grade 1–3 events occurred in 16.1% of cycles, and partial remission reached 52.6%. Symptom onset to first presentation had a median of 6 months (range 1–11.7); the program-attributable interval was 1–2 weeks. Unit cost was 223,000 US dollars (USD); the drug cost was 251.93 USD per patient, against 643–794 USD averted per course in travel, lodging, and subsistence, and 533 USD per cycle in personnel costs (base salary). Conclusions: This program showed that systemic treatment under remote supervision was delivered safely and feasibly without a resident medical oncologist, with household savings of two and a half to three times the drug cost. This proof of principle suggests that the model may be workable elsewhere, though the small sample and absence of a control group limit firmer conclusions.