Background: Breast cancer is the leading cause of female cancer mortality in sub-Saharan Africa, where over 70% of women present at advanced stages due to late diagnosis and financial barriers. Despite progress in oncology, few studies document patient perspectives on care quality in this region. Understanding these experiences is crucial because satisfaction influences adherence, trust, and outcomes. This study evaluated women’s perceptions of breast-cancer-care quality and the factors shaping satisfaction in Yaoundé, Cameroon. Methods: A mixed-methods, cross-sectional study was conducted between January and May 2025 at the Yaoundé General Hospital (HGY) and the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (HGOPY). Eligible participants were women with histologically confirmed breast cancer receiving active treatment and/or follow-up care within the preceding five years. Data were collected using a locally adapted questionnaire derived from validated quality-of-life instruments (EORTC QLQ-C30/BR23 and FACT-B) and qualitative focus-group discussions. Dimensions assessed included communication, timeliness, psychosocial support, and financial hardship. Data were analysed with SPSS v26 using χ2 tests and logistic regression; qualitative data underwent thematic analysis. Ethical approval was granted by the FMBS-UYI Ethics Committee. Results: Of 389 participants (mean age 45.2 ± 13 years), overall satisfaction was 65.4%. Independent predictors of satisfaction were good provider-patient communication (aOR 3.03, 95% CI 1.92 - 4.77; p < 0.001), psychosocial support (aOR 2.07, 1.22 - 3.50; p = 0.007), shorter waiting time (aOR 1.89, 1.21 - 2.95; p = 0.005), and higher income (aOR 2.79, 1.60 - 4.87; p < 0.001). Only 18% received psychosocial support and 81% reported financial difficulty. Qualitative themes revealed poor counselling, long waits, and emotional distress: “We are treated for the body, but no one asks about our fears”. Conclusion: Patient satisfaction with breast-cancer care in Yaoundé is moderate. Weak communication, inadequate psychosocial services, and financial strain limit perceived quality. Integrating psycho-oncology, improving provider-patient communication, and expanding financial protection are priorities for quality improvement in sub-Saharan Africa.
References
[1]
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R.L., Soerjomataram, I., et al. (2024) Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 74, 229-263. https://doi.org/10.3322/caac.21834
[2]
Anyigba, C.A., Awandare, G.A. and Paemka, L. (2021) Breast Cancer in Sub-Saharan Africa: The Current State and Uncertain Future. Experimental Biology and Medicine, 246, 1377-1387. https://doi.org/10.1177/15353702211006047
[3]
Igbokwe, K.K. (2024) Comparative Examination of Breast Cancer Burden in Sub-Saharan Africa, 1990-2019: Estimates from Global Burden of Disease 2019 Study. BMJ Open, 14, e082492. https://doi.org/10.1136/bmjopen-2023-082492
[4]
Ngo, U.E.M., Ntsama, J.A.M., Motolouze, K., Schouame, N.M.L.N., Atenguena, O.E., Ndoua, C.C.N., et al. (2024) Determinants of Early Survival of Breast Cancer Patients in Yaoundé-Cameroon. Open Journal of Obstetrics and Gynecology, 14, 487-501. https://doi.org/10.4236/ojog.2024.143042
[5]
Ngowa, J.D.K., Kasia, J.M., Yomi, J., Nana, A.N., Ngassam, A., Domkam, I., et al. (2015) Breast Cancer Survival in Cameroon: Analysis of a Cohort of 404 Patients at the Yaoundé General Hospital. Advances in Breast Cancer Research, 4, 44-52. https://doi.org/10.4236/abcr.2015.42005
[6]
Ndoua, C.C.N., Motolouze, K., Etienne, A., Ntsama, J.A.M., Rs, T.N., Tatsipie, W.L., et al. (2022) Survival of Patients Operated on for Breast Cancer in Yaounde: A Study of 166 Cases. Health Sciences and Diseases, 23, 27-30.
[7]
Jedy-Agba, E., McCormack, V., Adebamowo, C. and dos-Santos-Silva, I. (2016) Stage at Diagnosis of Breast Cancer in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. The Lancet Global Health, 4, e923-e935. https://doi.org/10.1016/s2214-109x(16)30259-5
[8]
Institute of Medicine (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.
[9]
Faller, H., Schuler, M., Richard, M., Heckl, U., Weis, J. and Küffner, R. (2013) Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients with Cancer: Systematic Review and Meta-Analysis. Journal of Clinical Oncology, 31, 782-793. https://doi.org/10.1200/jco.2011.40.8922
[10]
Prakash, O., Gupta, L.N., Ranjan, R., et al. (2020) Psychological Distress, Satisfaction with Care and Treatment Adherence among Cancer Patients. Indian Journal of Palliative Care, 26, 27-33.
[11]
Sando, Z., Fouogue, J.T., Fouelifack, F.Y., Fouedjio, J.H., Mboudou, E.T. and Oyono, J.L. (2014) Profil des cancers gynécologiques et mammaires à Yaoundé-Cameroun. Pan African Medical Journal, 17, Article 18. https://doi.org/10.11604/pamj.2014.17.28.3447
[12]
Esson Mapoko, B.S., Frambo, A., Saidu, Y., Bell Mbassi, E.D., Atenguena, E., Azemafac, K., et al. (2023) Assessment of Barriers to Optimal Cancer Control in Adult Cancer Treatment Centres in Cameroon. Ecancermedicalscience, 17, Article No. 1601. https://doi.org/10.3332/ecancer.2023.1601
[13]
Kibu, D.O., Dongho, G.B.D., Kepgang, E., et al. (2024) Breaking Barriers to Increase Subscription to Health Insurance in Cameroon. Nkafu Policy Institute.
[14]
Ebob-Anya, B. and Bassah, N. (2022) Psychosocial Distress and the Quality of Life of Cancer Patients in Two Health Facilities in Cameroon. BMC Palliative Care, 21, Article No. 96. https://doi.org/10.1186/s12904-022-00981-w
[15]
Brown, C.M., Kanu, C., Richards, K.M., Stevens, L., Sasane, R. and McAneny, B. (2022) Exploring Access to Care from the Perspective of Patients with Breast Cancer: A Qualitative Study. Cancer Medicine, 11, 2455-2466. https://doi.org/10.1002/cam4.4624
[16]
Prakash, A., Sardar, M., Shaikh, N., Inkollu, S., Dansih, M., Sharon, D.J., et al. (2020) The Perspective of a Breast Cancer Patient: A Survey Study Assessing Needs and Expectations. Cureus, 12, e9171. https://doi.org/10.7759/cureus.9171
[17]
Mulugeta, C., Emagneneh, T., Kumie, G., Ejigu, B. and Alamrew, A. (2025) Predictors of Survival among Breast Cancer Patients in Ethiopia: A Systematic Review and Meta-Analysis. Frontiers in Oncology, 14, Article ID: 1459613. https://doi.org/10.3389/fonc.2024.1459613
[18]
Adanu, K.K., Bansah, E.C., Adedia, D. and Aikins, M. (2022) Household Treatment Cost of Breast Cancer and Cost Coping Strategies from a Tertiary Facility in Ghana. PLOS Global Public Health, 2, e0000268. https://doi.org/10.1371/journal.pgph.0000268
[19]
Foerster, M., Anderson, B.O., McKenzie, F., Galukande, M., Anele, A., Adisa, C., et al. (2019) Inequities in Breast Cancer Treatment in Sub-Saharan Africa: Findings from a Prospective Multi-Country Observational Study. Breast Cancer Research, 21, Article No. 93. https://doi.org/10.1186/s13058-019-1174-4
[20]
Mohanty, S.K., Wadasadawala, T., Sen, S., Maiti, S. and E, J. (2024) Catastrophic Health Expenditure and Distress Financing of Breast Cancer Treatment in India: Evidence from a Longitudinal Cohort Study. International Journal for Equity in Health, 23, Article No. 145. https://doi.org/10.1186/s12939-024-02215-2
[21]
Zingue, S., Atenguena, E.O., Zingue, L.L., Tueche, A.B., Njamen, D., Nkoum, A.B., et al. (2021) Epidemiological and Clinical Profile, and Survival of Patients Followed for Breast Cancer between 2010 and 2015 at the Yaounde General Hospital, Cameroon. Pan African Medical Journal, 39, Article 182. https://doi.org/10.11604/pamj.2021.39.182.26866
[22]
Bellio, E. and Buccoliero, L. (2021) Main Factors Affecting Perceived Quality in Healthcare: A Patient Perspective Approach. The TQM Journal, 33, 176-192. https://doi.org/10.1108/tqm-11-2020-0274
[23]
Dansereau, E., Masiye, F., Gakidou, E., Masters, S.H., Burstein, R. and Kumar, S. (2015) Patient Satisfaction and Perceived Quality of Care: Evidence from a Cross-Sectional National Exit Survey of HIV and Non-HIV Service Users in Zambia. BMJ Open, 5, e009700. https://doi.org/10.1136/bmjopen-2015-009700
[24]
Magwesela, F.M., Kayange, P.A., Msemakweli, D.O. and Madinda, F.G. (2023) Experiences of Women with Breast Cancer in Sub-Saharan Africa: A Systematic Review. East and Central African Journal of Surgery, 28, 63-87.
[25]
Marnissi, B.E., Abbass, F., Charaka, H., Mouhoute, N., Tritha, A., Bouhafa, T., et al. (2019) Evaluation of Cancer Patient Satisfaction: A Cross-Sectional Study in the Radiotherapy Department, Hassan II University Hospital, Fez, Morocco. Advances in Public Health, 2019, 6430608. https://doi.org/10.1155/2019/6430608
[26]
Xesfingi, S. and Vozikis, A. (2016) Patient Satisfaction with the Healthcare System: Assessing the Impact of Socio-Economic and Healthcare Provision Factors. BMC Health Services Research, 16, Article No. 94. https://doi.org/10.1186/s12913-016-1327-4
[27]
Gupta, D., Rodeghier, M. and Lis, C.G. (2014) Patient Satisfaction with Service Quality as a Predictor of Survival Outcomes in Breast Cancer. Supportive Care in Cancer, 22, 129-134. https://doi.org/10.1007/s00520-013-1956-7
