Head and Neck Cancer in Burundi (2014-2023): Decade-Long Patterns, Outcomes, and Institutional Insights

Background: Head and neck cancer (HNC) is an emerging oncologic priority in Sub-Saharan Africa, yet longitudinal institutional data remain scarce. This study characterizes ten-year trends in epidemiology, stage at presentation, management, and outcomes at Burundi’s national referral hospital (CHUK). Methods: All histologically confirmed HNC cases managed between 2014 and 2023 were retrospectively reviewed. Variables included demographics, tumor site, AJCC stage, treatment, and survival. Descriptive and Kaplan-Meier analyses were conducted. Multivariable logistic regression identified independent predictors of advanced stage (or mortality), including variables with p < 0.20 in univariate analysis. Significance was set at p < 0.05 (two-sided). Missing data < 5% were handled by casewise deletion; if >5%, multiple imputation and sensitivity analyses were conducted. Treatment completion was defined as delivery of all prescribed curative modalities. Rural/semi-urban origin was classified by recorded residence (outside vs peri-urban Bujumbura). Results: Among 41,587 ENT consultations, 107 patients (0.26%) had HNC (median age 55 years; 63% male). Farmers comprised 50% of cases; rural origin of 54%. Tobacco/alcohol exposure ≈ 59%. The larynx (32%), pharynx (23%), and oral cavity (14%) were the leading sites. Squamous cell carcinoma dominated (55%). Only 33% underwent CT/MRI; median diagnostic delay of 5.5 months. Advanced stages (III - IV) accounted for 72%. Surgery was performed in 33%, chemotherapy in 15%, radiotherapy in 2%, while 50% received no curative therapy. Overall, 50.5% received no curative-intent therapy, 34% had documented palliative care, and 16.5% had none. Three-year overall survival (OS) was 37% (66% for stage I - II vs 24% for stage III - IV, p < 0.001). Early-stage disease was associated with 5.2-fold higher odds of treatment completion (95% CI: 1.8 - 15.0, p = 0.002). Conclusion: Over a decade, CHUK’s HNC caseload shows late presentation, limited radiotherapy access, and stage-driven outcomes. Priorities include: 1) earlier detection and streamlined referral, 2) surgical and pathology capacity expansion, 3) regionally networked radiotherapy access, and 4) prospective registry and follow-up strengthening. The CHUK experience provides a realistic baseline and institutional roadmap for oncology scale-up in Burundi.