Predictors of Locally Advanced Disease at Presentation and Clinical Outcomes Among Cervical Cancer Patients Admitted at a Tertiary Hospital in Botswana

Abstract

Lack of cervical cancer screening, vaginal bleeding, low abdominal pain, and unmarried status were associated with advanced disease at presentation. We recommend scale-up of cervical cancer screening and its integration into routine human immunodeficiency virus care. Capacity building in gynecologic oncology and palliative care services is currently critical.

Timelines to Cervical Cancer Diagnosis and Treatment at a Tertiary Hospital in Botswana

“…Electronic and paperbased medical records of 149 cervical cancer patients previously admitted at Princess Marina Hospital (PMH) from May 2012 to December 2014 were reviewed from August 2016 to February 2017. 4 Laboratory results are entered electronically while outpatient, inpatient, radiological and intraoperative clinical records are paper-based.…”

“…Using the World Health Organization sample size calculator and based on the cervical cancer incidence in Botswana of 22/100,000, the at-risk population of females over 25 years of age of 480,641, a 95% confidence interval and a 5% margin of error, a sample size of 108 was estimated and scaled up to 152 to cater for incomplete documentation. Details of sample size estimation are given in Nassali et al 4 Three incomplete entries were excluded. This paper is limited to the analysis of records with specific documentation of duration of symptoms (N=80), histology turnaround time (N=123) and the interval from diagnosis to definitive treatment modality (N=81).…”

“…initiation of definitive treatment in our study. 4 Patients evaluated and treated as outpatients leave with all their records and were not included. This diagnosis-to-definitive-treatment interval encompasses a complex interaction of various factors ranging from proper and timely patient evaluation at the various clinics and hospitals, efficient referral to PMH, histology turnaround time, booking and adherence to follow-up visits where coordinated linkage to chemoradiation or surgical intervention is finalized, government health-care costcover guarantee endorsement for outsourced radiotherapy services, to one's medical fitness to initiate the assigned definitive therapy (Figure 2).…”

“…Despite a relatively high level of awareness of cervical cancer among women in Botswana, 3 most patients still present late, with already locally advanced disease. 4 The introduction of gynecological cancer patient care in a multidisciplinary clinic setting since 2015 at the Princess Marina tertiary treatment center significantly reduced the number of visits required and time intervals needed to access lifesaving radiotherapy treatment by more than half. 5 However, specific timelines leading up to patient initial presentation, diagnosis and associated factors are not known.…”

Diagnosis of Advanced Cervical Cancer, Missed Opportunities?

“…In previous studies [15][16][17][18][19] , mainly from Africa, where health infrastructures for screening and prevention differ, the factors associated with a diagnosis at an advanced stage of cervical cancer were high parity as in our study, and also low education level, long distance from the health center, and young age at rst sexual intercourse, variables which were not available in our study, as well as living with HIV. The number of women with HIV in our population was insu cient to conclude, but it should be noted that we offer yearly gynecologic visits for these patients in our center.…”