Cancer Epidemiology and Decentralization Service Program Initiation: A Cross-Sectional Analysis of Hospital-Based Oncology Admissions and Cancer Service Disparities.

BACKGROUND: Cancer remains a growing public health challenge globally, with increasing demand for oncology services, particularly in resource-limited settings. In South Africa's Eastern Cape Province, tertiary hospitals face rising patient loads amid constrained infrastructure and late-stage presentation. This study assessed temporal trends, gender differences, and cancer-type distribution in oncology service utilisation at Nelson Mandela Academic Hospital (NMAH) from April 2023 to February 2025. METHODS: A retrospective quantitative observational time-series design was used. Monthly aggregated oncology service data were extracted from hospital records, including total cancer attendances, gender distribution, cancer types, and service utilisation indicators (new cases, follow-ups, chemotherapy, hormone therapy, palliative care, admissions, referrals, and mortality). Descriptive statistics, Pearson correlation, and simple linear regression were applied to assess temporal trends. Time (months) was the independent variable. RESULTS: A total of 16,368 cancer-related encounters were recorded, with a mean of 706.4 cases per month. Females accounted for 11,816 cases, significantly exceeding males (4552). Breast cancer was the most prevalent malignancy (5763 cases), followed by other cancers (4316) and cervical cancer (3616). Cervical cancer demonstrated a strong and statistically significant increasing trend (r = 0.619, p = 0.002), while lung cancer also showed a significant upward trend (r = 0.549, p = 0.007). Breast cancer showed a positive but non-significant trend (p = 0.163), whereas prostate and oesophageal cancers showed no significant temporal changes. Service utilisation was dominated by follow-up visits (14,761) and palliative care (16,911), indicating a high burden of advanced disease. Overall attendance showed an increasing trend, peaking at 1039 cases in April 2024, with seasonal declines in December-January. CONCLUSIONS: Oncology service utilisation at NMAH is increasing, with marked gender disparities and rising trends in cervical and lung cancers. The high reliance on palliative and follow-up care highlights late presentation and advanced disease burden. Strengthening early detection, screening programmes, and decentralised oncology service capacity is essential to address the growing cancer burden in this setting.