Cervical Cancer in Sub-Saharan Africa – a multinational population-based study on treatment guideline adherence

Objective:

Cervical cancer (CC) is the most common female cancer in many countries of Sub-Saharan Africa (SSA). We aimed to assess population-based adherence to treatment guidelines in this region under circumstances of low screening coverage, late stages at presentation, and limited resources in oncological diagnostics and treatment.

Methods:

Our observational registry study included nine population-based cancer registries in eight countries, including Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. We drew random samples of 44 – 125 patients per registry diagnosed in 2010 – 2016. Cancer-directed therapy was abstracted from hospital records and evaluated for degree of adherence to NCCN guideline 1.2010.

Preliminary Results:

Of the 600 patients included in the study (median age: 50 years), one sixth were diagnosed with FIGO stage IV disease and one sixth received cancer-directed therapy (CDT) with curative potential, with 5% guideline-adherent, 2% minor and 9% major deviations. No CDT could be found in 22% of patients with follow-up of ≥3 months. Guideline adherence was not assessed in 45% of the patients because no information beyond registry data could be traced (32%) or because of lack of information on stage or short follow-up (13%). The largest proportion of patients with guideline-adherent CDT was observed in Nairobi (Kenya), the smallest in Maputo (Mozambique). Among selected patients with sufficient information abstracted, deviations from optimal guideline-adherent therapy showed relevant decline in survival probability.

Conclusions:

We found that only one in six cervical cancer patients in SSA received CDT with curative potential. One-fifth of women definitely, and possibly up to two-third of women never accessed CDT, despite presenting with curable disease. Investments into more radiotherapy facilities, surgical training, and procurement of chemotherapies could radically change the inevitably fatal future of these women.

Funding:

Intramural Funding from the Research Department of the American Cancer Society and Martin Luther University Halle-Wittenberg, Germany.