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Lack of access to treatment is a key driver of impaired survival rates. This study assessed patient\u2010perceived barriers to chemotherapy in SSA according to the five dimensions of access to care: availability, accessibility, accommodation, affordability, and acceptability. Telephone interviews were conducted with 553 randomly selected cancer patients (or caretakers), registered between 2018 and 2019 in 11 urban population\u2010based cancer registries across nine countries in SSA. Malignancy types included breast, cervical, prostate, and colorectal cancer; non\u2010Hodgkin lymphoma; and Kaposi sarcoma. Patients rated barriers using a 3\u2010point Likert scale. Barriers to chemotherapy and their associations with patient characteristics were analysed using multivariate ordinal regression analysis. Major barriers included accessibility (cost of transport), affordability (cost of treatment, being absent from home), and acceptability (lack of knowledge\/awareness and fear of treatment). Results varied between countries: affordability was especially severe in the Republic of Congo, while in Gabon, fear of treatment prevailed. Knowledge and awareness were particularly concerning in Ethiopia and Zimbabwe. A combined educational level and self\u2010reported wealth variable, and national human development index (HDI) were consistently associated with reported barriers. Overall, 58.6% of participants received chemotherapy, while 13.2% were recommended chemotherapy but did not receive it. A higher HDI correlated with an increased probability of receiving treatment. A complex set of barriers influenced patients' non\u2010receipt of treatment. Regionally adapted strategies, including psychosocial support, financial assistance for vulnerable groups, and education, are essential to improve treatment uptake in SSA.<\/jats:p>","DOI":"10.1002\/ijc.70309","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T13:10:14Z","timestamp":1767100214000},"page":"2684-2696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient\u2010 and caregiver\u2010reported barriers to chemotherapy in nine sub\u2010Saharan African countries: A cross\u2010sectional survey among population\u2010based registries"],"prefix":"10.1002","volume":"158","author":[{"given":"Tamara","family":"K\u00f6nig","sequence":"first","affiliation":[{"name":"Global &amp; Planetary Health Working Group, Center of Health Sciences Medical Faculty of the Martin Luther University Halle\u2010Wittenberg  Halle (Saale) Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-1080","authenticated-orcid":false,"given":"Nikolaus Christian Simon","family":"Mezger","sequence":"additional","affiliation":[{"name":"Global &amp; 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