241 Care for cervical cancer patients in uganda is scarce; evaluation of clinical presentation and management in kampala

Abstract

Objectives The treatment of cervical cancer patients in Uganda is complicated by late diagnosis due to the unavailability of timely screening and the availability of only one tertiary hospital, the Uganda Cancer Institute (UCI) in Kampala. This research evaluated the presentation and clinical management of cervical cancer patients at UCI. Methods We retrospectively analyzed patient files of all cervical cancer patients presenting to UCI between January 2017 and March 2018. The clinical management of patients with early (FIGO 1A-2A) and advanced (FIGO 2B-4B) stage disease were evaluated using national and international treatment guidelines. Results Files of 583 patients were included, representing 9.1% of the annual estimated incidence (6413) of cervical cancer in Uganda. The majority (86.2%) of patients presented with advanced stage disease and 27.3% were known HIV-positive. More than half of patients (55.9%) were lost to follow-up before or during treatment. The national treatment targets for surgery and palliative care were achieved, but the target for chemo-radiation was not met. When radiotherapy was available, 50.0% of patients with early stage and 64.4% with advanced stage were treated in accordance with international guidelines. Conclusions Adequate treatment is available to only a minority of cervical cancer patients in Uganda. Furthermore, less than half of the patients presenting at UCI complete treatment and not all patients are treated according to national and international guidelines. In order to decrease the burden of cervical cancer in Uganda, investment in chemotherapy, radiotherapy and surgical capacity is critically needed, as well as accessible prevention programs and efficient referral pathways.