Patient Education Emerges as a Lifeline for Cancer Treatment Adherence Across Africa

Cancer care in Africa is quietly failing at one of its most basic steps: getting patients to complete their treatment. A new scoping review published in Supportive Care in Cancer has mapped the evidence on patient education and treatment adherence in low- and middle-income African countries, and its findings are both sobering and unexpectedly hopeful. The review, led by Dejen T. Alem of Debre Markos University and the University of Wollongong together with colleagues at Flinders University and the University of New South Wales, found that adherence to cancer treatment in these settings can fall as low as 20 percent, a figure that stands in stark contrast to outcomes in well-resourced health systems. Yet the same body of evidence shows that structured, culturally sensitive education, delivered by nurses, allied professionals and even through simple mobile phone messages, can meaningfully shift that trajectory.

The scale of the problem provides the backdrop. In 2022, roughly 10 million people worldwide died of cancer, and low- and middle-income countries accounted for approximately 65 percent of those deaths. African low- and middle-income countries alone contributed around 7.8 percent of global cancer deaths that year. As populations age, ageing remains the single greatest risk factor for cancer, and incidence continues to climb globally. Against this rising tide, adherence, defined as the degree to which a patient consistently follows their healthcare provider’s recommendations for cancer care, becomes a decisive variable. A treatment plan that is never completed offers little benefit, no matter how sophisticated the medicine.

To understand what actually helps patients stay the course, the research team followed the Joanna Briggs Institute methodology for scoping reviews and reported their findings according to the PRISMA-ScR guidelines, with the protocol registered in the PROSPERO database. They searched four electronic databases, the Cochrane Library, MEDLINE through PubMed, CINAHL and Web of Science, from inception to March 2025, supplemented by Google Scholar, manual reference-list searches and targeted website searches of major cancer organisations. The search retrieved 3,785 studies. After duplicates were removed and a rapid first-pass screening applied, 251 articles underwent title and abstract screening, 29 proceeded to full-text review, and 11 studies ultimately met the inclusion criteria: English-language, peer-reviewed primary studies involving adults with cancer in low- and middle-income African countries, in which an educational intervention aimed at improving treatment adherence was implemented or evaluated.

Those 11 studies spanned eight countries: three conducted in Ethiopia, three in Kenya, two in Tanzania, and one each in Malawi, Rwanda, South Africa and Uganda. Together they included 3,246 participants, most commonly people with cervical cancer followed by breast cancer, with sample sizes ranging from 40 to 825 and mean ages spanning 18 to 66 years. Six studies were experimental, including two randomised controlled trials and four pre- and post-test designs; three were observational cross-sectional studies; and two were purely qualitative, with one experimental study also embedding a qualitative component. The team appraised methodological quality using the Mixed Methods Appraisal Tool, finding that all studies met the screening criteria, although some non-randomised studies showed limitations around participant representativeness, adjustment for confounding and completeness of outcome data.

The technical detail of what these interventions looked like is revealing. Education methods included direct lectures, role playing and demonstration-based approaches, group education sessions facilitated by a researcher or healthcare professional, one-on-one sessions using motivational interviewing, and combinations of group and individual formats. The intensity of the interventions ranged from as little as two days to as long as five months, although most lasted from minutes to three weeks. Delivery modes leaned increasingly on technology: internet-based support interventions, educational videos, short message service (SMS) support and even a full-process information management system. A 2024 Kenyan study evaluating SMS support found that this simple delivery mode significantly enhanced adherence to chemotherapy, a striking demonstration that low-cost mobile technology can carry a substantial clinical payload.

Nurses emerged as the most frequent providers of patient education, appearing in three studies, followed by allied healthcare professionals in two, with three studies relying on master’s degree-holding researchers to facilitate the sessions. The content of the education varied widely, covering tumour-specific disease and treatment knowledge, available aid resources and organisational service information, outpatient consultation arrangements and public lectures. This variety, the authors note, reflects both the creativity of local teams and the absence of any standardised framework for what patient education in these settings should contain, a gap that the review identifies as a key obstacle to building cumulative evidence.

From the narrative synthesis, conducted through tabulation, textual description and thematic concept mapping, three overarching themes crystallised. The first was safe and meaningful patient education: programmes work best when they are personalised and tailored to the context and circumstances of the patient and their support people, an idea consistent with wider evidence that tailored education improves adherence, quality of life and cancer outcomes. The second theme was the power of interpersonal interactions among patients, healthcare professionals and family caregivers. Studies from Kenya, Rwanda, South Africa and Uganda demonstrated that effective communication among these groups builds trust, shared understanding and emotional support, all of which positively influence adherence. The third theme, and the most structurally sobering, was the challenge of social structures, the recognition that adherence is shaped by forces far beyond any individual patient’s willpower.

Those structural forces are formidable. Low literacy and low health literacy hinder patients’ understanding of cancer and its treatment, fostering myths that cancer is incurable and undermining informed decision-making. Cultural and religious beliefs can lead patients to delay, discontinue or forgo evidence-based treatment in favour of alternatives such as holy water or traditional healers. Economic burden, encompassing the cost of care, medications, transport and lost wages, often compounded by the absence of health insurance, forces some patients to seek financial help through social media while others simply abandon treatment. Layered on top are health system failures: shortages of trained oncology staff, poor rural transport, overcrowding, long waiting times and limited specialised services concentrated in urban centres. The review’s central analytical point is that these factors intersect and compound one another, meaning that education alone, however well designed, cannot carry the full weight of improving adherence.

The authors are candid about the limits of the evidence base. The 11 included studies are few, heterogeneous in objectives, designs and outcome measures, and largely lacking long-term follow-up data or standardised adherence measurement tools. The restriction to English-language publications and the exclusion of grey literature may have omitted relevant work, and, perhaps most importantly, the review cannot speak to the vast population of people who never access cancer care at all. Prior research has also tended to evaluate outcomes almost exclusively from the patient’s perspective, excluding family caregivers and healthcare professionals whose views might reshape the picture entirely.

Even so, the implications are clear and actionable. The review argues that future research should develop context-specific, evidence-based, tailored educational interventions co-designed with African patients, family caregivers and healthcare professionals, and tested in longitudinal studies capable of capturing effects on adherence and longer-term outcomes such as quality of life. The success of SMS-based support in Kenya, the value of visual and interactive formats for populations with limited literacy, and the consistent importance of trust-building communication all point toward practical, affordable strategies. What the evidence ultimately confirms is that keeping a cancer patient on treatment in a resource-constrained setting is not a single intervention but a system: education that respects literacy and culture, clinicians who communicate, families who are informed, and structures that do not price patients out of survival. The review, published open access as volume 34, article 986 of Supportive Care in Cancer, gives clinicians and policymakers across the continent their clearest map yet of where that system is breaking down, and where, with relatively modest investment, it can be repaired.

Subject of Research: Patient education strategies and factors influencing cancer treatment adherence in low- and middle-income African countries

Article Title: Factors, including patient education, that impact cancer treatment adherence in low- and middle-income African countries: a scoping review

Article References: Alem, D. T., Currow, D. C., Davidson, P. M., & Brunelli, V. N. (2026). Factors, including patient education, that impact cancer treatment adherence in low- and middle-income African countries: a scoping review. Supportive Care in Cancer, 34(10), Article 986. https://doi.org/10.1007/s00520-026-11230-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11230-8

Keywords: cancer, treatment adherence, patient education, low- and middle-income countries, Africa, health literacy, scoping review, SMS interventions, oncology nursing, health systems, social determinants of health, supportive care