“People Think the Cancer Ward Is Just a Place to Die”: Healthcare Worker Perspectives on Cancer Stigma, Mental Health, and Psychosocial Support in Northern Tanzania

Abstract

Background: Cancer is a growing public health challenge in Sub-Saharan Africa, where rising incidence and substantial morbidity associated with common cancers such as cervical and prostate cancer continue to strain individuals, families, and health systems. In addition to limited oncology infrastructure, workforce shortages, and scarce treatment resources, patients often face psychosocial challenges such as stigma, cultural beliefs that may hinder care engagement, and illness-related emotional distress, with these needs often exacerbated by broader health system constraints. Despite increased emphasis on holistic support in cancer care in many parts of the world, psychosocial support services remain extremely limited in many African oncology settings. There is a need for research to understand these gaps from the provider perspective, which will inform future intervention efforts.Methods: We conducted semi-structured, in-depth interviews with 20 healthcare workers at the Cancer Care Centre of Kilimanjaro Christian Medical Center in Moshi, Tanzania. In addition to the qualitative interviews, participants completed six brief Likert-style questions assessing perceptions of psychosocial needs and support in oncology care. Interviews explored staff perspectives on psychosocial support needs, cancer-related stigma, cultural beliefs, traditional medicine use, and gaps in mental health services within oncology care. Participants were recruited using purposive sampling at the cancer care center, with efforts made to include workers who were most representative of the range of roles involved in cancer care delivery. Interviews were conducted in English or Swahili based on participant preference, lasted 30 to 60 minutes, and were audio-recorded with consent. Transcribed and when applicable, translated data were analyzed using a team-based applied thematic content approach and NVivo 15 software. Results: Workers described stigma as a foundational barrier to care-seeking, with both cancer related and mental health-related stigma shaping patient outcomes. According to healthcare workers, stigma was often driven by misconceptions about cancer, including beliefs that it is contagious or a death sentence, as well as fears of financial hardship and social abandonment. Stigma contributed to significant psychological distress among patients, including depression, anxiety, and hopelessness, particularly following diagnosis and during prolonged treatment. Cultural beliefs and reliance on religious or traditional healing practices were frequently reported as substitutes for biomedical treatment, often perceived as less stigmatizing and more accessible than hospital-based care. Psychosocial services were described as minimal or absent, particularly for children and adolescents, despite the perception that young patients face heightened distress. Workers recommended staff training, increased integration of counseling services, and community-level education to reduce stigma and improve patient support. Conclusion: There is an urgent need for sustainable and culturally grounded psychosocial interventions to strengthen cancer care in low-resource African settings. Community-based education and advocacy efforts are needed to improve cancer literacy, encourage care seeking, and reduce stigma affecting patients with cancer and their families. Policy-level action is also required to address structural barriers to care, particularly the financial and logistical burdens associated with cancer treatment.