Assessing the impact of policy implementations on treatment duration for patients with locally advanced cervical cancer in a northern province of Argentina.

Abstract

e23135 Background: Cervical cancer represents a public health challenge in low and middle-income countries (LMIC). Instituto Misionero del Cancer (IMC) is a public tertiary center located in Misiones, Argentina. In 2020, two policy implementations were introduced to improve the patient journey in the locally advanced cervical cancer setting, including the creation of a patient navigation program and a brachytherapy unit in the province. Methods: A hospital-based registry comprising 951 patients diagnosed between January 2015 and October 2024 was analyzed. A subgroup analysis was performed including patients with stages IB2-IVA. Overall survival was estimated using the Kaplan-Meier method, considering the date of radiotherapy initiation as the starting point. Key patient characteristics were considered in univariate and multivariate models, including total treatment duration, ECOG, FIGO staging and patient educational level. Cox regression analysis was used for model assessment. Results: 702 patients with locally advanced cervical cancer and adequate follow-up information were identified in the registry. Mean age was 46.8 (CI95% 45.9-47.8). 84% (n = 586) had squamous histology, 53% (n = 374) were diagnosed with stage IIIA or higher, and 26% (n = 181) only attended elementary school. Median follow up was 28.4 months (CI95% 26.1-31). Multivariate models showed that certain characteristics were independently associated with overall survival, including total treatment duration (p = 0.02), FIGO staging (p = 0.03) and ECOG (p < 0.001). Treatment intervals of less than 5 or more than 12 weeks were associated with lower overall survival in our cohort (adj. HR 1.82 CI95% 1.32-2.51; adj. HR 1.84 CI95% 1.07-3.18; p < 0.001). Since both implementations, the number of patients that achieved treatment duration intervals of 5-12 weeks increased from 43.3 to 62.8% (p < 0.001). Conclusions: Although increasing overall survival rates have been observed in developed countries, centralized planning and the incorporation of specific policy implementations with measurable outcomes are essential to overcome health barriers commonly seen in LMICs. Our study emphasizes the need for further evaluation of regional needs and the design of implementation programs as central components to improving cancer-specific outcomes.