Assessing Factors Associated With Survival Among Cervical Cancer Patients in Kenya: A Retrospective Follow-up Study

Abstract

Background: Cervical cancer ranks as the fourth most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. In Kenya, cervical cancer is the second most commonly diagnosed cancer after breast cancer and the leading cause of cancer death in women. It is estimated that by the end of 2018, cervical cancer will be responsible for 5,250 (11%) new cases and 3,286 (11.84%) deaths in Kenya. Methods: We conducted a retrospective follow-up study to estimate the overall survival of women treated for cervical cancer in Kenya. Medical records were reviewed to extract information for generating a quantitative data set, and the chisquare test was used to test for associations between patient outcomes and various sociodemographic and clinical factors. To estimate overall survival after treatment, we used Kaplan-Meier survival analysis, the logrank test, and Cox proportional hazards regression.Results: A total of 481 patient records were included in this study. From the bivariate analysis, 4 factors demonstrated a statistically significant association with survival: access to care (P=.049), stage of disease at diagnosis (P<.001), type of treatment received (P<.001), and whether or not treatment was initiated and completed (P<.001). The overall 5-year survival estimate for women with cervical cancer was 59%. However, 396 (82.3%) women were lost to follow-up; with no deaths observed after the first year, the overall survival estimate is only accurate for the first year. Conclusion:The high rate of loss to follow-up appears to be characteristic of cancer care in Kenya and highlights the difficulties in conducting survival studies in low-resource settings with low coverage of vital registration and a lack of centralised national administrative systems. Despite the study's limitations, the results support evidence whereby latestage diagnosis, deficiencies in cancer management, and limited cancer care services, in particular, have been found to contribute to poor patient outcomes in sub-Saharan Africa.

Prevalence and epidemiological profile of cervical cancer patients attending Nyeri County and Referral Hospital, Kenya: a review of records 2017 – 2022.

“…A hospital based study in Ethiopia reported a 10.1% prevalence of cervical cancer while in Ghana a prevalence of 50% was reported(Dunyo et al, 2018) signifying a variation in prevalence across Africa. In this current study, majority of patients with cervical cancer were between 50-59 years as compared to KNH study that had the highest cases between 40-49-years(Osok et al, 2018). A Zambian study also reported a peak of cervical cancer age range of 40-49 years implying that this age group was the high-risk group for cervical cancer in Zambia(Kalubula et al, 2021).…”

“…These ndings are not different from what has been reported in other hospitals in Kenya. Previous studies done in Moi Teaching and referral Hospital and Kenyatta National Hospital reported a fatality rate of 43.2% and 41% respectively(Mwaliko et al, 2022;Osok et al, 2018). However, other studies in Africa have reported a higher fatality rates.…”

“…The prevalence rate was 5.16% indicating a signi cant proportion of cases managed in the hospital. However, a study done in Kenyatta National Hospital showed a cervical cancer prevalence of 13.2%(Osok et al, 2018), while a study in Meru county reported a 20% prevalence(Kobia et al, 2019). The slightly higher prevalence both in KNH and Meru County than what is reported in NCRH, may be due to the fact that the KNH being a national hospital deals majorly with National referral cases countrywide compared to NCRH which manages regional referrals.…”

Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study

“…A few cohort studies have examined possibly-related factors, though none was primarily focusing on stage at diagnosis as the main outcome. Osok and colleagues conducted a retrospective cohort study to assess factors associated with cervical cancer survival; they noted treatment type and completion status as main determinants of survival ( Osok et al, 2018 ). Another retrospective cohort focusing on time to death found age above 50 years, late-stage at diagnosis, receiving no treatment and living with HIV as key factors ( Seifu et al, 2022 ).…”

A Hospital-Based Survey Assessing the Health Facility-Level Factors that Contribute to Delayed Diagnosis of Cervical Cancer; Patients Views

“…cancer diagnosis increases the risk of poor cancer outcomes (4). Early diagnosis (Stages I and II), is associated with a 98% 5-year survival rate, while delayed diagnosis (Stages III and IV), is associated with lower rates (17% 5-year survival rate) (5).…”