Knowledge, perceptions, and experiences regarding cancer among final-year medical interns in the kivu sub-region of the Democratic Republic of the Congo: a multi-institutional cross-sectional study

Abstract Background: Cancer imposes a growing burden in sub-Saharan Africa, with mortality-to-incidence ratios near 65%. In the conflict-affected Kivu sub-region of the Democratic Republic of the Congo, late-stage presentation, absent specialized oncology services, and weak health systems place final-year medical interns at the frontline of care. Evidence on their cancer-related competencies remains scarce. This study aimed to assess knowledge, perceptions, and experiences regarding cancer among final-year medical interns in North Kivu, South Kivu, and Maniema, and to identify factors associated with knowledge levels. Methods: A multi-institutional cross-sectional survey was conducted from 1 March to 31 May 2026. An expert-reviewed and pilot-tested questionnaire comprising 74 knowledge items (score range, 0–74) and 5 perception items (score range, 0 - 5) was administered online or face-to-face across seven institutions. A beta-binomial mixed-effects model with university as a random intercept assessed factors associated with knowledge performance. Results: Among 260 participants (mean age, 26 ± 2 years; 63% male), the mean knowledge score was 46.2 ± 9.3 (≈62%). Only 1.2% achieved good knowledge, while 52.7% had insufficient or poor knowledge. Performance was highest for cancer definition (78.1%) and lowest for the single palliative-care item (21.9%), awareness and information sources (43.2%), and risk factors (57.9%). Perceptions were predominantly favorable (82.3%), although only 24.2% ranked cancer control as a top national priority. Higher perception scores were associated with higher odds of correct responses (aOR, 1.19; 95% CI, 1.12–1.26; P < .001). Originating from outside the DRC was associated with higher odds of correct responses (aOR, 1.69; 95% CI, 1.13–2.55; P = .012), although this association was exploratory (n=10). Conclusions: Final-year medical interns showed moderate cancer knowledge, with important gaps in prevention, risk factors, and the single palliative-care item despite predominantly favorable perceptions. Strengthening undergraduate oncology education is warranted.