Published in PLOS One on 2025-12-31, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Joshua Kanaabi Muliira, Allen Naamala Mayanja, Prossy Nandawula, Jane Frances Anyango, Scovia Nalugo Mbalinda
Source: PLOS One • DOI 10.1371/journal.pone.0339827
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The increasing burden of cancer in resource-limited settings like Uganda puts pressure on healthcare systems and leaves many patients’ needs unmet. These unmet needs impact service uptake, perceptions of care, and health outcomes. However, the extent and effect of unmet care needs on patients’ health outcomes remain poorly characterised.
A cross-sectional study involved 170 adult cancer patients at the Uganda Cancer Institute (UCI). Participants filled out validated instruments such as the Hospital Anxiety and Depression scale (HADS), the EORTC QLQ-30 (Quality of life scale) and the Supportive Care Needs Survey (SCNS-SF34). Descriptive statistics, correlation and regression analyses examined the relationship between unmet needs and health outcomes.
Nearly half (45.9%) of participants reported clinically significant anxiety symptoms, while 35.9% had depressive symptoms. The highest unmet needs were in physical/daily living (mean = 73.59 ± 20.26), psychological (51.77 ± 18.24), and health system/information domains (38.96 ± 19.59). Poor quality of life was observed in role (18.14 ± 27.01) and social functioning (9.41 ± 18.48). Fatigue (β = 0.23, p < 0.01) and anxiety (β = 0.20, p < 0.01) were the strongest predictors of overall unmet needs.
Cancer patients in Uganda experience substantial unmet needs, particularly in physical, psychological, and informational support, which are strongly linked to worse mental health and quality of life. To improve patient outcomes, integrated interventions targeting symptom management, psychosocial support, and health system strengthening are urgently needed.
Introduction
It is estimated that by the year 2040, there will be 28.4 million new cancer cases globally, with the majority (65% to 95%) being in developing countries due to the high burden of risk factors and demographic, lifestyle, and epidemiological transitions [1]. The burden of cancer morbidity and mortality is evident in resource-limited settings such as those in Eastern Sub-Saharan Africa, since some have the world’s highest fatality rates (75.5%) for breast cancer [2]. Uganda, a country of 47 million people, is in Eastern Sub-Saharan Africa and has a cancer case fatality rate of 80% [2]. Ugandans are estimated to have a cancer age-standardized incidence rate and death rate of 200 per 100000 and 150 per 100000, respectively [2]. In 2018, approximately 60000 Ugandans had cancer and needed specialized care, but only 5% had access to medical services at the country’s only comprehensive cancer treatment centre, the Uganda Cancer Institute [3].
The number of Ugandans with undiagnosed cancer due to a lack of access to health care is estimated to be much higher. Reports from the Uganda Cancer Registry show that cancer incidence is rapidly increasing, especially cancer of the prostate, breast, cervix, oesophagus, colorectum, and liver [4]. Other reports have highlighted an association between quickly rising incidences of cancer and HIV/AIDS [3]. This growing burden of cancer in Uganda is taking place on the backdrop of a cancer care system with challenges, such as the limited capacity for cancer prevention and early detection [5], late presentation and diagnosis, and lack of access to cancer treatments [6] and other resources. For instance, the country is experiencing persistent shortages of blood products for cancer patients [7–9], and lacks formal programs to train nurses in oncology, supportive care, and psychosocial care for cancer patients [10–12].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Joshua Kanaabi Muliira, Allen Naamala Mayanja, Prossy Nandawula, Jane Frances Anyango, Scovia Nalugo Mbalinda. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Prevalence and factors associated with treatment delay among colorectal cancer patients at Mulago National Referral Hospital and the Uganda Cancer Institute: A cross-sectional study
- Evidence brief: Fertility in the Shadow of Cancer: Experiences of Reproductive Loss Among Women with Gynecological Cancers in Ghana
- Evidence brief: Prevalence of cancer related fatigue and its associated factors among adult cancer patients in eastern Ethiopia: A cross-sectional study
