Public cancer investment linked to better survival at Uganda’s leading cancer centre

Uganda’s Uganda Cancer Institute has published a five-year analysis of cancer outcomes showing that where patients live, how they earn a living, and whether they have HIV all shape their chances of survival, while rising public investment in cancer services appears to track with improving results. The retrospective study, published in BMC Cancer, drew on electronic medical records from January 2020 to December 2024 and covered the five most common cancers in the country.

During the study period, 12,438 new patients were registered with breast, prostate, Kaposi sarcoma, cervical, or esophageal cancer. Cervical cancer was the largest group, accounting for 29.4 percent of registrations, followed by breast cancer at 24.5 percent, prostate cancer at 21.4 percent, esophageal cancer at 16.2 percent, and Kaposi sarcoma at 8.5 percent.

To compare survival across cancer types, the researchers calculated mortality-to-incidence ratios, or MIRs, a proxy measure for survival that relates the number of deaths to the number of new cases. Prostate cancer had the lowest MIR at 6.3 percent, followed by Kaposi sarcoma at 11.5 percent, cervical cancer at 14 percent, breast cancer at 23 percent, and esophageal cancer at 33 percent. A low MIR suggests relatively better survival for a given cancer type, although the measure is an indirect indicator rather than a direct survival estimate.

The team then modelled the MIRs over the five years using beta regression with a logit link, adjusting for clinical and sociodemographic factors as well as public funding. This statistical approach allowed them to estimate how each factor was associated with outcomes while holding the others constant.

Geography emerged as a clear factor. Living outside metropolitan Kampala was associated with a higher mortality-to-incidence ratio, with a coefficient of 0.120 and a 95 percent confidence interval of 0.064 to 0.177, a statistically significant association with a p value below 0.001. Patients living outside the capital region, where the Uganda Cancer Institute is based, therefore faced measurably worse outcomes than those within it.

Employment status and HIV infection also mattered. Informal employment and HIV-positive status were both linked to worse outcomes, while patients diagnosed with early-stage cancer had a lower mortality-to-incidence ratio. The pattern is consistent with the idea that earlier detection and better access to care improve survival, though the retrospective design of the study means these associations cannot be read as causal effects.

The study also examined the role of public financing. Trends suggested improved outcomes as public funding increased, but the adjusted association between funding and outcomes was not statistically significant. The authors describe sustained public investment in cancer services as positively associated with improved patient outcomes, while explicitly cautioning that causality and cost-effectiveness could not be established in this retrospective, single-institution design.

The context for these findings is a rising cancer burden in Uganda, as in many low- and middle-income countries, with most patients presenting late because of limited access to diagnostic and treatment services. Sustained government investment, strengthened by the Uganda Cancer Institute Act of 2016, has enabled the development of a comprehensive cancer care system that includes palliative care. The researchers note that systematic documentation of the impact of these investments has been limited, which motivated the study.

The study’s scope carries important limitations. It was a retrospective cross-sectional analysis of records from a single institution, the Uganda Cancer Institute, covering only five cancer types among adult patients with confirmed diagnoses. The mortality-to-incidence ratio is a proxy for survival rather than a direct measure, and the data cannot establish that funding changes caused the observed outcome trends.

Despite these constraints, the authors conclude that the findings support Uganda’s investment model as a promising approach to strengthening cancer care. They argue that expansion through comprehensive national cancer control programs, emphasizing prevention, early detection, and regional cancer centres, is essential to improve equity of access, particularly for patients living outside the capital.

Subject of Research: Cancer outcomes and public financing at the Uganda Cancer Institute

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

Article References: Angucia, B. S., Niyonzima, N., Anecho, E., Biyinzika, D., Ngobi, B., Nabyonga, J., Jatho, A., & Orem, J. (2026). Cancer outcomes in low and middle-income countries: the role of clinical, sociodemographics, and public funding as drivers. BMC Cancer. https://doi.org/10.1186/s12885-026-17278-3

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17278-3

Keywords: Uganda Cancer Institute, cancer outcomes, mortality-to-incidence ratio, low- and middle-income countries, public financing, cervical cancer, breast cancer, prostate cancer, Kaposi sarcoma, esophageal cancer, HIV, health equity