Cervical cancer treatment trajectories in a sample of cervical cancer patients in the Democratic Republic of the Congo: A retrospective descriptive study.

Abstract

e17519 Background: With limited curative-intent treatment options in the country, cervical cancer is the leading cancer in terms of mortality in the Democratic Republic of Congo (DRC). No prior local study has characterized patient treatment trajectory patterns, from diagnosis to treatment to outcome or has presented relevant longitudinal data from urban and rural settings. This study aimed to fill this gap with data from a sample of cervical cancer patients in the DRC. Methods: We retrospectively reviewed patient data from 2014-2023 in two DRC hospitals, Hopital General (HG, urban, renamed CHU Renaissance) and IME Kimpese (IME, rural). We completed missingness, descriptive, and bivariate (t-test and χ 2 , at α= .05) analyses of patient sociodemographic and clinical characteristics, overall and across study sites. We assessed concordance of the treatment ordered with FIGO guidelines (2014). Overall and by study site, we chronologically and visually presented clustered trajectories, initially stemming from nodes of FIGO stage at diagnosis (I-IV), from which weighted patient paths emerge into nodes of type of treatment ordered/received (none, surgery alone, surgery + chemotherapy, chemotherapy alone, and palliative only; also grouped as curative-intent and palliative/none), whose outgoing paths lead into patient outcome nodes (alive, died, lost to follow-up [LTFU]). Results: A total 404/732 cases (246 at HG, 158 at IME) and 101/240 identified deaths were included in the full analysis, totaling 252.8 person-yrs, with baseline mean (SD) age of 53.4 (12.0) yrs and median (IQR) follow-up time at 0.19 (0.05, 0.64) yrs. Overall, 165 (40.8%) were FIGO stage II and 279 (69.1%) late-stage (IIb-IVb) cancers (60.9% at HG, 39.1% at IME; p-value <.0001), 86 (21.3%) treatments ordered were guideline concordant, 221 (54.7%) treatments received were curative-intent (57.3% at HG, 73.4% at IME; p-value <.0001), with 146 (36.1%) being surgery only; 143 (35.4%) never started their treatment while 123 (30.4%) completed it (mostly surgery alone), 208 (51.5%) were LTFU and 101 (25.0%) died. The most common trajectory of treatments was patients in stage II (165 [40.8%]), with surgery alone as treatment received (146 [36.1%]), and subsequently loss to follow-up (208 [51.5%]), followed by stage III (32.4%), with no treatment (35.4%), and resulting in death (25.0%). Conclusions: In this first-of-its-kind study reported for the DRC, most cases were difficult to track, diagnosed at a late stage, and, due to limited options available, treatment ordered was often discordant with guidelines. No treatment or surgery alone (mostly in rural setting) were often the next step after diagnosis. LTFU – which could involve untracked deaths – and death were the main outcomes, as observed in other sub-Saharan African settings. Further investigation with nationally representative data is warranted.