Barriers to accessing cancer care services in Eastern Cape and Mpumalanga provinces of South Africa: cancer survivors’ perspectives

The World Health Organization’s 2022 estimates reported 20 million new cancer cases and 9.7 million deaths, reaffirming cancer as the second leading global cause of mortality. Equitable care requires access to prevention, early detection, treatment, and follow-up for all populations. In rural South Africa, access is shaped by structural, economic, systemic, and sociocultural factors. This study explored cancer survivors’ experiences in the Eastern Cape and Mpumalanga to understand the barriers they face in obtaining care. A qualitative study was conducted between November 2021 and January 2022 using semi-structured interviews with adult cancer survivors receiving care at tertiary referral hospitals in the rural Eastern Cape and Mpumalanga provinces of South Africa. Purposive and convenience sampling were used to recruit participants aged 18 years and older who could provide informed consent and describe their care experiences. Interviews explored diagnostic pathways, comorbidities, and barriers to accessing cancer services. Data were analysed inductively using Braun and Clarke’s thematic analysis, with emergent themes subsequently interpreted using the World Health Organization health system building blocks framework. The study included 33 cancer patients aged 30–74 years attending oncology clinics. Most participants were women (n = 25) and unemployed (n = 23). Breast cancer was the most common diagnosis (n = 14), followed by cervical cancer (n = 9), with smaller numbers of prostate, thyroid, stomach and Kaposi’s sarcoma cases. Breast and cervical cancers accounted for over two-thirds of all diagnoses. Four themes that emerged were poor infrastructure, financial barriers, environmental and contextual challenges, and health system obstacles, illustrating the multidimensional barriers to rural cancer care. This study identifies structural, economic, and social barriers limiting cancer survivors’ access to care in rural South Africa, causing diagnostic delays, treatment interruptions, and increased vulnerability. Participant narratives reveal critical gaps in the health system and highlight the need for culturally grounded, community-responsive reforms. Enhancing access requires decentralised oncology services, strengthened referral pathways, transport and education support, and integrated psychosocial care. Coordinated efforts among policymakers, providers, and communities, informed by comparative rural–urban research, are essential to achieve equitable cancer care.