Cervical cancer in Sub‐Saharan Africa: a multinational population‐based cohort study on patterns and guideline adherence of care
Journal – The Oncologist
Article type – Journal research article – Clinical research
Publication date – Feb – 2021
Authors – Mirko Griesel, Tobias P Seraphin, Nikolaus CS Mezger, Lucia Hämmerl, Jana Feuchtner, Walburga Yvonne Joko‐Fru, Mazvita Sengayi‐Muchengeti, Biying Liu, Samukeliso Vuma, Anne Korir, Gladys C Chesumbai, Sarah Nambooze, Cesaltina F Lorenzoni, Marie‐Thérèse Akele‐Akpo, Amalado Ayemou, Cheick B Traoré, Tigeneh Wondemagegnehu, Andreas Wienke, Christoph Thomssen, Donald M Parkin, Ahmedin Jemal, Eva J Kantelhardt
Keywords – access to care, cervical cancer, Population‐based, Radiotherapy Survival, Sub-Saharan Africa
Open access – Yes
Speciality – Obstetrics and Gynaecology, Surgical oncology
World region Central Africa, Eastern Africa, Southern Africa, Western Africa
Country: Benin, Ethiopia, Ivory Coast, Mali, Mozambique, Uganda, Zimbabwe
Language – English
Submitted to the One Surgery Index on February 16, 2021 at 7:35 am
Cervical cancer (CC) is the most common female cancer in many countries of sub‐Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS).
Our observational study covered nine population‐based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44‐125 patients diagnosed 2010‐2016 were selected in each. Cancer‐directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (USA) Guidelines.
Of 632 patients, 15.8% received CDT with curative potential: 5.2% guideline‐adherent, 2.4% with minor and 8.2% major deviations. CDT was not documented or without curative potential in 22%; 15.7% were diagnosed FIGO IV disease. Adherence was not assessed in 46.9% (no stage or follow‐up documented 11.9%) or records not traced (35.1%). The largest share of guideline‐adherent CDT was observed in Nairobi (49%), the smallest in Maputo (4%). In FIGO I‐III patients (n=190), minor and major guideline deviations were associated with impaired OS: hazard rate ratio (HRR) 1.73, 95% confidence interval (CI) 0.36‐8.37; and HRR 1.97, CI 0.59‐6.56 respectively. CDT without curative potential (HRR 3.88, CI 1.19‐12.71) and no CDT (HRR 9.43, CI 3.03‐29.33) showed substantially worse survival.
We found only one in six cervical cancer patients in SSA received CDT with curative potential. At least one‐fifth and possibly up to two thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of man
OSI Number – 20936