Trajectories of cervical cancer patients through the health systems of Colombia and Guatemala

Abstract

e13800 Cervical cancer (CC) is the 2nd most prevalent cancer among women from low and middle-income countries. Latin America faces the 2nd highest mortality globally, but substantial differences are observed between countries. Colombia (COL) and Guatemala (GTM) are upper-middle income countries; however, they significantly differ in CC mortality. We analyzed trajectories of CC patients in retrospective cohorts from GTM and COL. Patients 18 years and older, newly diagnosed with locally advanced CC were included from June 2023 to January 2019. Patients were enlisted in referral centers from different healthcare subsystems in every country. A comparison was done on patterns of care, time to care, resource use, trajectory clusters, and mortality. Overall, 201 and 237 patients from GTM and COL were included, respectively. Mean age was 51.2. Education and public coverage were lower in GTM, whereas indigenous origin and rural housing were lower in COL. Median follow-up was 29.2 and 21.6 months in GTM and COL. COL patients showed lower chemotherapy compliance, and lower administration of IMRT and brachytherapy was observed in GMT. Mortality was higher in GTM over COL (8.4 and 5.7 per 1,000 women-months; respectively). The multivariate analysis only showed disease relapse, and the use of extended-field radiotherapy without IMRT significantly associated with higher mortality (OR 14.8 95%CI 7.42-31.01 and 2.2 95%CI 1.09-4.58). On the contrary, the use of brachytherapy was significantly associated with lower mortality (OR 0.34 95%CI 0.15-0.80). In total 9 trajectories of care were identified in GTM and 26 in COL. Despite differences in social determinants, trajectories of care, and treatment compliance; a lower access to standard treatment was observed as the major contributing factor to higher mortality. A need to focus on treatment effectiveness is highlighted as an objective mean to evaluate quality of care. Treatment pattern Guatemala Colombia p value Concomitant chemoradiation (%) 98.6 94.1 0.03 Type of external beam radiotherapy (%)IMRTExtended field 23.460.6 100.051.0 <0.01 0.08 Brachytherapy (%) 81.5 95.3 <0.01 Treatment compliance (%) 74.4 78.5 0.31 Supportive care (%) 4.3 56.1 <0.01 Time to treatment Time from diagnosis to treatment (median months) 1.9 2.9 <0.01 Time to treatment completion (median months) 2.1 2.4 <0.01