Unmet palliative care needs and determinants among women with breast and cervical cancer and their caregivers in Ethiopia.

INTRODUCTION

Breast and cervical cancers are the leading causes of cancer related morbidity and mortality among Ethiopian women. These cancers carry burdens including impacts on femininity, marital relationships, and family stability. Yet palliative care (PC) remains under addressed.

OBJECTIVE

This study assessed unmet PC needs and determinants among women with breast and cervical cancer and caregiver burden in Ethiopia.

METHODS

Institution based cross sectional study was conducted from February to April, 2025 at Tikur Anbessa Specialized Hospital, and Hawassa University Comprehensive Specialized Hospital, Ethiopia. Using systematic random sampling, 480 patients and 458 caregivers were enrolled. Data were collected using Supportive and Palliative Care Indicators Tool for Low Income Settings, African Palliative Care Association tool, and the three item Oslo Social Support Scale. Multivariable logistic regression identified factors associated with higher PC needs. Statistical significance set at p ≤ 0.05.

RESULTS

Using the mean as the threshold for dichotomisation, 261 patients (54.4%) were having higher PC needs. Psychosocial distress was prevalent domain (72.1%), followed by economic hardship (62.3%), physical symptoms (56.7%), and spiritual concerns (52.9%). Breast cancer patients reported higher psychosocial distress than cervical cancer patients (75.6% vs. 66.5%, p = 0.03). Patients in Sidama had higher unmet needs (74.6%) than in Addis Ababa (51.5%, p = 0.001). Among cervical cancer patients, chemotherapy receipt was the predictor (AOR = 4.21, 95% CI: 2.18-8.13); among breast cancer patients, late stage diagnosis was associated (AOR = 2.84, 95% CI: 1.52-5.31). Difficulty accessing hospitals (AOR = 1.89, 95% CI: 1.02-3.66), preference for local PC (AOR = 2.65, 95% CI: 1.15-6.10), and Muslim religious affiliation for cervical cancer (AOR = 2.35, 95% CI: 1.02-5.41) and breast cancer (AOR = 2.18, 95% CI: 1.01-4.70) were linked to higher PC needs. Social support was protective (AOR = 0.30). 75.5% caregiver reported high emotional strain and 59.8% high financial burden.

CONCLUSION

Psychosocial distress was the most common need requiring comprehensive PC service. Given the protective role of social support and patient preference for local care, community based PC models should be integrated into primary health systems. The caregiver burden demands investment in caregiver support programs.