Surgical candidacy and treatment initiation among women with cervical cancer at public referral hospitals in Kampala, Uganda: a descriptive cohort study
| Autor: | Lee-may Chen, Stefanie Ueda, Miriam Nakalembe, Jane Namugga, Carol Nakisige, Megan J. Huchko, Megan Swanson |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Referral medicine.medical_treatment Clinical Sciences Uterine Cervical Neoplasms Global Health Cervical Cancer Hysterectomy chemotherapy Cohort Studies adult radiotherapy Clinical Research Internal medicine Epidemiology Medicine Humans Uganda Stage (cooking) Referral and Consultation Adjuvant Cancer Neoplasm Staging Cervical cancer Other Medical and Health Sciences Radiotherapy business.industry gynaecological oncology Prevention General Medicine medicine.disease Hospitals Radiation therapy Chemotherapy Adjuvant adult oncology Candidacy Public Health and Health Services Radiotherapy Adjuvant Female epidemiology business Cohort study |
| Zdroj: | BMJ open, vol 10, iss 12 BMJ Open, Vol 10, Iss 12 (2020) BMJ Open |
| Popis: | ObjectivesThis study aimed to report the proportion of women with a new diagnosis of cervical cancer recommended for curative hysterectomy as well as associated factors. We also report recommended treatments by stage and patterns of treatment initiation.DesignThis was an observational cohort study. Inperson surveys were followed by a phone call.SettingParticipants were recruited at the two public tertiary care referral hospitals in Kampala, Uganda.ParticipantsAdult women with a new diagnosis of cervical cancer were eligible: 332 were invited to participate, 268 met the criteria and enrolled, and 255 completed both surveys.Primary and secondary outcomes measuresThe primary outcome of interest was surgical candidacy; a secondary outcome was treatment initiation. Descriptive and multivariate statistical analyses examined the associations between predictors and outcomes. Sensitivity analyses were performed to examine outcomes in subgroups, including stage and availability of radiation.ResultsAmong 268 participants, 76% were diagnosed at an advanced stage (IIB–IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 km of Kampala (OR 3.10, 95% CI 1.20 to 8.03) and prior screening (OR 2.89, 95% CI 1.22 to 6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage disease (IA–IIA), but was associated with recommended treatment modality (chemoradiation vs primary chemotherapy) for locally advanced stage (IIB–IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was recommended.ConclusionWomen presented to public referral centres in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Most were able to initiate treatment. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy. |
| Databáze: | OpenAIRE |
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