Factors associated with survival and lost to follow-up of cervical cancer patients in a tertiary cancer centre in rural Kerala

Abstract

Cancer cervix is the second common cause of cancer death in India. It is the most curable form of any human cancer if detected at the precancerous stage. Although several factors determine the survival of the disease, the clinical stage at presentation is the single most important predictor of long-term survival. The present study aimed to describe the performance and follow-up status and 5-year survival experience of the cervical cancer patients registered between 2010 and 2011 by the hospital registry of Malabar Cancer Centre, Kerala, and factors affecting lost to follow-up and survival among them. The case sheets of 227 patients retrospectively scrutinized during May-July 2014. The mean age of patients was 58.8 years (standard deviation = 11.67 years). The majority of the patients completed the initially planned treatment, but a low proportion of patients were likely to be on regular follow-up. This study revealed that most of the patients registered at the hospital only at an advanced stage. Using Kaplan-Meier method, the estimated 5 years survival rate was found to be 66.8%. It was noted that performance status before treatment and Federation of Gynecology and Obstetrics staging were significantly associated with lost to follow-up and survival rate majority of the cervical cancer patients are observed to be highly noncomplaint to complete treatment and on follow-up. Thus, these findings stress the importance of counseling family members regarding the importance of follow-up and formulating public health policies aimed at increasing the awareness and implementation of cervical cancer screening programs in North Malabar.

Smartphone‐Based Application for Tele‐follow‐up of Patients with Endocrine Disorders in Context of a LMIC: A Compliance, Satisfaction, Clinical Safety and Outcome Assessment

“…A survey conducted in central state of India, Madhya Pradesh, reported availability of laboratory services, human resources, drugs, equipments and point-of-care supply domains to be 37.1, 49.0, 56.1, 67.9 and 80.9%, respectively, at community health centers (CHCs) and 11.8, 18.2, 44.2, 55.1, and 55.3%, respectively, at primary health centers (PHCs) [3]. Another report from a southern state (Kerala) reported that among the 227 cervical cancer patients 216 (95.2%) of the patients completed the initially planned treatment and among them only 30.4% had regular follow-up, while the rest 69.6% were lost to follow-up [4]. This is the usual scenario across India, where patients visit a tertiary care center in the advanced stage of the disease, take initial treatment and then are unable to come for follow-up.…”

Staging and Management of Cervical Cancer at the Colposcopy Clinic of Bangabandhu Sheikh Sheikh Mujib Medical University (BSMMU), Bangladesh

“… 8 26 27 On the other hand, comparatively higher proportion of patients presented with stage I disease in rural Kerala (12.80%) and Trivandrum (11.10%), where state is running national CC screening program. 28 29 These studies stressed on the importance of formulating public health policies with improving awareness and implementation of CC screening programs. Nepal developed screening services in limited areas.…”

Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda

“…Many studies have investigated the association between late stage disease at presentation and low survival rather than LTFU [11,12,18,19]. A few studies that have assessed stage at presentation and LTFU in South India showed similar associations between advanced stage at presentation and being LTFU [8,10]. Patients arriving into care at a later stage of illness may seek care elsewhere or outside the system if cure within the formal system is deemed unlikely.…”