Cervical cancer management in Zimbabwe (2019–2020)

Abstract

Background Globally, cervical cancer is the fourth most commonly diagnosed cancer amongst women, and it is especially common in low- and middle-income countries (LMICs). The aim of the study was to determine the current patterns and characteristics of CC management in Zimbabwe in the HIV pandemic era, including the knowledge, attitude and practice of patience. Methods The study was a mixed method which incorporated a cross-sectional survey of 408 CC patients which was conducted from October 2019 to September 2020 using an interviewer administered paper questionnaire. The study was conducted at Parirenyatwa hospital, the only cancer treating public health facility in Harare, Zimbabwe. Differences in study outcome by categorical variables were assessed using the Person Chi-square (χ2) test. Odds ratios (unadjusted and adjusted) and 95%CIs for potential risk factors associated with the outcome were estimated using logistic regression model. Results From a total of 408 CC patients recruited into the study no prevention mechanism was available or known to these patients and only 13% knew that CC is caused by Human papillomavirus. Only 87 (21%) had ever been screened for CC and 83 (97%) of those who had been screened had the visual inspection with acetic acid procedure done. Prevention (screening uptake) is statistically high among the educated (with secondary education OR = 9.497, 95%CI: 2.349–38.390; with tertiary OR = 59.381, 95%CI: 11.937–295.380). Late presentation varied statistically significantly with marital status (high among the divorced, OR = 2.866; 95% CI: 1.549–5.305 and widowed OR = 1.997; 95% CI: 1.112–3.587), was low among the educated (Tertiary OR = .393; 95% CI: .166-.934), low among those living in the rural (OR = .613; 95% CI: .375-.987), high among those with higher parity OR = 1.294; 95% CI: 1.163–1.439). Less than 1% of the patients had surgery done as a means of treatment. Radiotherapy was administered to 350 (86%) of the patients compared to chemotherapy administered to 155 (38%). A total of 350 (86%) have failed to take medication due to its unavailability, while 344 (85%) missed taking medication due to unaffordability. Complementary and alternative medicines were utilized by 235 (58%). Majority, 278 (68%) were HIV positive, mainly pronounced within age (36–49 years OR = 12.673; 95% CI: 2.110–76.137), among those with higher education (secondary education OR = 4.981; 95%CI: 1.394–17.802 and in those with no co-morbidities (893.956; 95%CI: 129.611–6165.810). Conclusion CC management was inadequate from prevention, screening, diagnosis, treatment and palliative care hence there is need to improve CC management in Zimbabwe if morbidity and mortality are to be reduced to acceptable levels. Education helped improve prevention, but reduces chances of diagnosis, working as a doubled edged sword in CC management Prevention was high among the educated. Those in rural areas experience poor CC management. It should be noted that general education is good; however it must be complimented by CC awareness to improve CC management outcomes holistically. Cervical cancer management services need to be decentralized so that those in rural areas have easy access. Given that those with co-morbidities and high parity have better CC management, CC services need to be tied to co-morbidity and antenatal/post-natal care and management services.

Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review

“…The adverse effects of the COVID − 19 pandemic on the socio-economic status and patient's well-being may have additionally contributed to the low treatment adherence rates. The present ndings relate to those published by authors in Zimbabwe's Parirenyatwa hospital where radiotherapy uptake was reported in about 86% of the patients, with only 38% administered with chemotherapy [13]. In both settings, similar health system constraints are reported [13,14,24].…”

“…Chemoradiation treatment non-compliance has been reported in studies done previously in low-and middleincome countries [13,15,16], however, most of these studies were done in populations outside Uganda. In the present study, the rate of compliance to chemoradiation treatment among cervical cancer patients at Uganda Cancer Institute was determined.…”

“…However, the bene cial effects of chemoradiation therapy can only be realized if patients adhere to treatment [8]. Good compliance or adherence implies that the patient follows recommendations by the treatment provider on timing, dosage, and frequency of medication [9], however, this remains a signi cant challenge for many people living with cancer in resourcelimited settings [10][11][12][13][14]. Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [13,15,16], with patient loss to follow-up of up to 15% or greater [17,18].…”

“…Good compliance or adherence implies that the patient follows recommendations by the treatment provider on timing, dosage, and frequency of medication [9], however, this remains a signi cant challenge for many people living with cancer in resourcelimited settings [10][11][12][13][14]. Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [13,15,16], with patient loss to follow-up of up to 15% or greater [17,18]. In a more recent study done in Zimbabwe's Parirenyatwa hospital, radiotherapy uptake was reported in about 86% of the patients, with only 38% receiving concurrent chemotherapy [13].…”

“…Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [13,15,16], with patient loss to follow-up of up to 15% or greater [17,18]. In a more recent study done in Zimbabwe's Parirenyatwa hospital, radiotherapy uptake was reported in about 86% of the patients, with only 38% receiving concurrent chemotherapy [13]. Many of these studies however, have been done in populations outside Uganda.…”