Five-year survival status of women diagnosed with cervical cancer and treatment impact at Tikur Anbessa hospital, Addis Ababa, Ethiopia; a retrospective cohort study

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Addis Ababa University


Background: Worldwide, cancer of the cervix is one of the most common causes of cancer mortality among women, with about 288,000 deaths each year. While it is the second leading cause of cancer mortality among adult women globally, it is the most common cause of mortality in the economically emerging countries including in sub-Saharan Africa. The reason for this high mortality is likely to be the poor access to early detection or screening and treatment services. There is no sufficient Published data on the treatment outcome of cervical cancer in Ethiopia. This study would contribute to the evidence regarding the treatment outcome of cervical cancer. Objectives: To assess the five-year survival among women who attended for treatment of cervical cancer. Methods: A hospital based retrospective cohort study was conducted at the Oncology Department of Tikur Anbessa Specialized Hospital (TASH). Records of patients with a first diagnosis of cervical cancer were selected from a two-year medical records of cervical cancer patients who attended the oncology department of TASH from September 11/2012 to September 11/2014GC.Survival Outcome was evaluated over the subsequent five-year period until 2014GC. Because of the practical challenges of determining actual survival status, continuation in follow up (vs dropout from follow up) was used as a proxy indicator of survival. Descriptive statistics was employed to summarize basic socio-demographic and clinical variables. KaplanMeier and Cox-regression analysis was used to evaluate the potential role of various treatment modalities on survival outcome. Crude and adjusted Hazard ratios with 95% Confidence intervals were presented as measure of association. Statistical tests resulting in a p-value of less than 0.05 were considered statistically significant. Results: Among 1008 cancer patients who were diagnosed and started Treatment at Tikur Anbessa Specialized Hospital Oncology Center during the two-year selection period ,418 had cervical cancer and were included in the current study. At the end of the five-year only 9.9% (40) had survived in follow-up. For the majority, stage at presentation was late. Patients who arrived with later stages (Stage-III) cervical cancer had lower follow-up survival probabilities compared with earlier stage [stage-0, (Carcinoma in situ)] [Adjusted Hazard Ratio=2.17; 95% -CI= 1.40,3.40]. Those who had received combination therapy (Radiotherapy, chemotherapy and surgery) have better survival probability than those who were treated with Radiotherapy and Chemotherapy alone [Adjusted HR= (0.29, 95%CI, 0.84, 2.20), (2.52,95%-CI,1.80,3.40), and (2.02,95%-CI,1.10,3.80)] respectively. Conclusion and recommendation: The clinical factors identified as factors for survival in follow-up (e.g., stage at presentation) appear to justify using survival in follow-up as a proxy measure of survival. However, this is extremely crude proxy. Thus, well planned prospective study of survival is needed. Nevertheless, if the crude assumption is correct, ensuring access to early diagnosis, and treatment is an urgent priority for improving survival of patient with cervical cancer in Ethiopia. There is a need of creating awareness, primary prevention by vaccination, and increasing early detection programs to increase early stages at presentation which gives more opportunity to appropriate treatment. Furthermore, expanding more treatment centers and implementation of advanced Technology like Linear accelerator, rachytherapy and PET-scan needs urgent attention.



Cervical cancer, Survival status; Early Detection; Delay in Treatment impact.