Cancer outcomes in low and middle-income countries: the role of clinical, sociodemographics, and public funding as drivers

Cancer burden is rising in Uganda, as in many low- and middle-income countries (LMICs), with most patients presenting late due to limited access to diagnostic and treatment services. Sustained government investment, strengthened by the Uganda Cancer Institute Act of 2016, has enabled development of a comprehensive cancer care system, including palliative care. However, systematic documentation of the impact of these investments has been limited. This study examines trends in cancer outcomes at the Uganda Cancer Institute (UCI), highlighting the role of public financing and clinical and sociodemographic factors in shaping cancer care. We conducted a retrospective cross-sectional study using institutional Electronic Medical Records (EMR) from January 2020 to December 2024. The study population included all adult patients with confirmed diagnoses of breast, prostate, Kaposi sarcoma (KS), cervical, and esophageal cancer—the five most common cancers in Uganda. Descriptive statistics summarized sociodemographic and disease-related variables, while mortality-to-incidence ratios (MIRs) were calculated as a proxy for survival. MIRs were modelled over five years using beta regression with a logit link, adjusting for clinical and sociodemographic factors as well as public funding. During the study period, 12,438 new patients were registered with the five cancers of interest. Cervical cancer accounted for 29.4%, breast 24.5%, prostate 21.4%, esophageal 16.2%, and KS 8.5%. Prostate cancer had the lowest MIR (6.3%), followed by KS (11.5%), cervical (14%), breast (23%), and esophageal cancer (33%). Living outside metropolitan Kampala was associated with higher MIR (β = 0.120, 95% CI [0.064–0.177], p < 0.001). Informal employment and HIV-positive status were linked to worse outcomes, while early-stage cancer was associated with lower MIR. Trends suggested improved outcomes with increased public financing, though the adjusted association was not statistically significant. Sustained public investment in cancer services is positively associated with improved patient outcomes. Although causality and cost-effectiveness could not be established in this retrospective, single-institution design, the findings support Uganda’s investment model as a promising approach to strengthening cancer care. Expansion through comprehensive national cancer control programs, emphasizing prevention, early detection, and regional cancer centres, is essential to improve equity of access.