Abstract
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.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 chi-square 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.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.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 late-stage 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.
Highlights
The Global Cancer Incidence, Mortality, and Prevalence (GLOBOCAN) database indicates that, in 2018, cervical cancer will be responsible for 570,000 new cases and 311,000 deaths globally.[1]
Cervical cancer incidence and mortality rates have been on the decline in many populations worldwide, evidence suggests that these rates are increasing in sub-Saharan Africa.[2,3]
This is catastrophic considering the highest regional age-standardised incidence rates (ASIR) and mortality rates (ASMR) for cervical cancer are in Africa, with
Summary
The Global Cancer Incidence, Mortality, and Prevalence (GLOBOCAN) database indicates that, in 2018, cervical cancer will be responsible for 570,000 new cases and 311,000 deaths globally.[1]. East African Health Research Journal 2018 | Volume 2 | Number 2 elevated rates observed in southern (ASIR, 43.1; ASMR, 20.0), eastern (ASIR, 40.1; ASMR, 30.0), and western Africa (ASIR, 29.6; ASMR, 23.0).[1] In Kenya it is estimated that, in 2018, cervical cancer will be responsible for 5,250 (11%) new cases and 3,286 (11.84%) deaths. This makes cervical cancer the second most commonly diagnosed cancer in Kenya after breast cancer and the leading cause of cancer death in women.[4]. To estimate overall survival after treatment, we used Kaplan–Meier survival analysis, the logrank test, and Cox proportional hazards regression
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