Beyond Palliation: Economic Feasibility of Integrating Cancer-Directed Therapy Into Home-Based Palliative Care, a Retrospective Cohort Study in Rural Uganda

Abstract Background Palliative care is an essential component of comprehensive cancer management. However, in many low-resource settings, limited access to oncologic and surgical care leads patients to forgo potentially curative treatment and pursue palliation, even when their cancer is treatable. For palliative care programs operating with limited resources, understanding the organizational costs of providing symptom management alone versus facilitating access to cancer-directed treatment is critical for determining how best to allocate scarce healthcare resources. This study compares the organizational costs of providing palliative care with facilitated cancer-directed treatment (PC + T) versus palliative care alone (PC). Methods We conducted a retrospective cohort study of 76 breast and cervical cancer patients receiving care from 2019–2021 at Rays of Hope Hospice Jinja, a palliative care center in Jinja, Uganda, which provides symptom management, psychosocial support, nutritional and financial assistance, and care coordination free to their patients. Total program cost, including facilitation for oncologic treatment (if applicable), transport, and labor, were analyzed. Categorical variables, such as cancer type and HIV status, were analyzed using Chi-squared or Fisher’s tests. Continuous variables, such as age, costs, days enrolled, and appointment frequency, were compared using Mann-Whitney U test. Results There were 43 PC patients and 33 PC + T patients. The median daily cost per patient was $20.95 for PC versus $8.00 for PC + T. The PC + T group remained enrolled three times longer (median 401 days vs. 119 days; p = 0.002), but total costs per patient showed no significant difference (median $2,156 for PC vs. $2,952 for PC + T; p = 0.582). This is due to the PC + T group’s lower cost per day and lower visit frequency (0.50 vs. 1.30 visits per month; p < 0.001). Conclusions Palliative care combined with facilitation to oncologic treatment is equally – if not more – cost-efficient for the palliative care program than palliation alone, likely because effective treatment limits disease progression, reducing additional visits and palliation. These findings suggest that integrating timely access to oncologic treatment within palliative care services may not only reduce patient morbidity and mortality but also lower overall healthcare program costs.