Analysis of Factors Contributing to the Low Survival of Cervical Cancer Patients Undergoing Radiotherapy in Kenya

Maranga, Innocent O.; Hampson, Lynne; Oliver, Anthony W.; Gamal, Anas; Gichangi, Peter; Opiyo, A; Holland, Cathrine; Hampson, Ian N.

doi:10.1371/journal.pone.0078411

Cited by 85 publications

(92 citation statements)

References 47 publications

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“…4). Our predicted survival probability was similar to a Kenyan study which showed a progressively lower survival probability with advancing stage of disease at diagnosis with an overall predicted 2-year survival of less than 20 % [15]. The overall median survival in the Kenyan cohort was 15.0 months following diagnosis and concurrent chemo-radiation therapy at a cervical cancer treatment center.…”

Section: Discussionsupporting

confidence: 82%

Cervical cancer survival in a resource-limited setting-North Central Nigeria

Musa

Nankat

Achenbach

et al. 2016

Infect Agents Cancer

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BackgroundOrganized cervical cancer screening services are presently lacking in Nigeria contributing to late presentation and diagnosis of invasive cervical cancer cases (ICCs) at advanced stages in most gynecologic units in Nigeria. We evaluated outcomes of ICCs diagnosed at Jos University Teaching Hospital (JUTH) to better understand factors associated with cervical cancer survival in similar resource limited settings.MethodsWe performed a retrospective cohort study with a prospective follow up data to estimate time from diagnosis to mortality among women diagnosed with ICCs at JUTH. Women who were diagnosed with ICCs between January 2011 and May 2013 were followed up after initial evaluation at JUTH and subsequent referral for specialized treatment in one of the national oncology treatment centers in Nigeria. The main outcome measured was all-cause mortality rate and overall survival (OS) after diagnosis of ICC. The follow up data were updated and observations were censored March 31, 2015. The overall death rate was estimated using the total number of death events and the cumulative follow-up time from diagnosis to death. We conducted Cox proportional hazard regression to assess factors associated with death.ResultsA total of 65 histologically confirmed ICCs were followed up. The median age of the cohort was 50 years with a median parity of 7. The HIV prevalence in the cohort was 8.2 % and the majority (72.3 %) were diagnosed at advanced stages (AD) of ICC. Simple total abdominal hysterectomy (TAH) was performed in 38.9 % of patients who were diagnosed at early stage disease (ED). After a cumulative follow up of 526.17 months, 35 deaths occurred with an overall death rate of 79.8 per 100 women-years. We also found a significantly higher hazard of death in women with AD (HR = 3.3) and baseline anemia (HR = 3.0). In the subgroup of women with ED, the OS was significantly higher for those who had TAH compared to those who did not (26.5 versus 11.6 months respectively).ConclusionAdvanced stage disease and baseline anemia were independently associated with higher death rate. Cervical cancer patients diagnosed at early stages by non-oncologic specialist in settings lacking the standard of care may benefit from improve survival with simple hysterectomy.

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Section: Discussionsupporting

confidence: 82%

Cervical cancer survival in a resource-limited setting-North Central Nigeria

Musa

Nankat

Achenbach

et al. 2016

Infect Agents Cancer

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“…This has been reported in other studies. 7,24 Removing the tumor by surgery, using radiotherapy for primary treatment, and using chemotherapy to prevent metastasis may be more beneficial to the patient.…”

Section: Resultsmentioning

confidence: 99%

Factors Contributing to the Low Survival Among Women With a Diagnosis of Invasive Cervical Cancer in Ghana

Nartey¹,

Hill

Amo‐Antwi

et al. 2017

Int J Gynecol Cancer

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“…All but the least progressed stages of cervical cancer have high case-fatality rates in this region of the world (estimated to be greater than 50 %) due to poor access to effective treatment modalities. Women with advanced cases have 2-year survival rates of less than 20 % [3], and the average life-years lost due to cervical cancer is greater than 18 [4]. Effective screening programs utilizing cervical cytology have decreased the number of cases of ICC in developed nations.…”

Section: Introductionmentioning

confidence: 99%

Invasive cervical cancers in the United States, Botswana and Kenya: HPV type distribution and health policy implications

Ermel

Qadadri

Tong

et al. 2016

Infect Agents Cancer

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BackgroundMore deaths occur in African women from invasive cervical cancer (ICC) than from any other malignancy. ICC is caused by infection with oncogenic types of human papillomavirus (HPV). Co-infection with the human immunodeficiency virus (HIV) accelerates the natural history of ICC, and may influence the HPV type distribution. Because HPV vaccines are available, this malignancy is theoretically preventable, but the vaccines are largely type-specific in protection against infection. Data on specific HPV types causing ICC in African women is limited, and many studies utilized swab samples rather than actual cancer tissue. A previous study using archived, ICC tissue from women in Botswana identified an unusual HPV type distribution. A similar study was therefore performed in a second sub-Saharan country to provide additional information on the HPV type distribution in ICC.MethodsArchived, formalin-fixed, paraffin-embedded ICCs were acquired from women in the United States, Kenya, or Botswana. DNA was extracted and HPV genotyping performed by Roche Linear Array. HIV sequences were identified in ICCs by PCR.ResultsHPV types 16 or 18 (HPV 16/18) were identified in 93.5 % of HPV-positive ICCs from the U.S., 93.8 % from Kenya, and 61.8 % from Botswana (p < 0.0001). Non-HPV 16/18 types were detected in 10.9 % of HPV-positive cancers from the U.S., 17.2 % from Kenya, and 47.8 % from Botswana (p < 0.0001). HIV was detected in 2.2, 31.5, and 32.4 % from ICCs from the U.S., Kenya, or Botswana, respectively (p = 0.0002). The distribution of HPV types was not significantly different between HIVinfected or HIV-uninfected women. The percentages of ICCs theoretically covered by the bivalent/quadrivalent HPV vaccines were 93.5, 93.9, and 61.8 % from the U.S., Kenya and Botswana, respectively, and increased to 100, 98, and 77.8 % for the nanovalent vaccine.ConclusionsHPV 16/18 caused most ICCs from the U.S. and western Kenya. Fewer ICCs contained HPV 16/18 in Botswana. HIV co-infection did not influence the HPV type distribution in ICCs from African women from the two countries. Available HPV vaccines should provide protection against most ICCs in the U.S. and Kenya. The recently developed nanovalent vaccine may be more suitable for countries where non-HPV 16/18 types are frequently detected in ICC.Electronic supplementary materialThe online version of this article (doi:10.1186/s13027-016-0102-9) contains supplementary material, which is available to authorized users.

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Analysis of Factors Contributing to the Low Survival of Cervical Cancer Patients Undergoing Radiotherapy in Kenya

Cited by 85 publications

References 47 publications

Cervical cancer survival in a resource-limited setting-North Central Nigeria

Cervical cancer survival in a resource-limited setting-North Central Nigeria

Factors Contributing to the Low Survival Among Women With a Diagnosis of Invasive Cervical Cancer in Ghana

Invasive cervical cancers in the United States, Botswana and Kenya: HPV type distribution and health policy implications

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