Cervical cancer treatment patterns & outcomes in sub-Saharan Africa: Findings from a multi-institutional cancer dataset.

Abstract

e17511 Background: Cervical cancer is a significant public health concern in Sub-Saharan Africa (SSA), where it remains the leading cause of cancer-related mortality among women. SSA has the highest global incidence and mortality rates, with an estimated 110,300 new cases and 76,700 deaths in 2020. Despite this burden, data on patient characteristics and treatment outcomes remain limited. This study aims to address these gaps by analyzing current treatment patterns and outcomes for cervical cancer in SSA. Methods: A cancer dataset was established at 4 major teaching hospitals in Ghana, Kenya, Ethiopia, and Rwanda to capture data on patient demographics, disease characteristics, and treatment modalities. The dataset encompasses all cancer patients seen between 2016-2023, with over 9,000 cases collected to date. The primary objective of the dataset was to assess impact of COVID-19 pandemic on cancer care in SSA. This study conducted a retrospective analysis of cervical cancer cases within the dataset utilizing descriptive metrics. Results: A total of 2,326 patients were analyzed, with a median age at diagnosis of 56 y (48–65) and 53% having health insurance. The majority had squamous cell carcinoma (87%) and presented with locally advanced disease (FIGO stages IIB–IVA, 88%). Treatment primarily consisted of concurrent chemoradiotherapy (CRT, 34%) or radiotherapy (RT) alone (30%), while smaller proportions received chemotherapy (CT) alone (1.2%) or surgery (1.3%). A total of 33% of patients received no cancer therapy. Among 1,524 patients treated with RT, 1,180 received external beam RT with a median dose of 46 Gy in 23 fractions, using 2D planning in 60% and 3D planning in 40% of cases. Additionally, 25 patients underwent brachytherapy, with 58% receiving low-dose-rate and 42% high-dose-rate treatments. Of 1,011 patients treated with CT, 85% (n=844) completed the intended course, with a median of 4 cycles, primarily delivered concurrently with RT (95%). Only a few received CT as adjuvant (4.8%), neoadjuvant (1.6%), or palliative (3.4%) therapy. Platinum-based regimens were most common, with 43% receiving platinum monotherapy and 5% receiving platinum-taxane combinations. By the end of treatment, 27% (n=633) achieved disease-free status. After a median follow-up of 47 months (range,37–55), 42% were alive, 7% had died, and 53% were lost to follow-up with unknown vital status. Conclusions: This study reveals significant challenges in management and follow-up of cervical cancer in SSA. Most patients were diagnosed at advanced stages, with 32% receiving no treatment and 53% of treated patients lost to follow-up. These findings highlight barriers to early diagnosis, treatment access, and continuity of care. Addressing these issues requires expanding early diagnostic services, increasing vaccination coverage, strengthening healthcare infrastructure, and improving patient retention.