Factors associated with loss to follow-up and treatment interruption among patients with ovarian cancer at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Ovarian cancer presents a significant challenge in gynecological oncology, with over 1.4 million new cases and 700,000 deaths globally in 2020. Treatment typically involves surgery and chemotherapy, both of which significantly impact patients' quality of life. However, there is limited understanding of the factors contributing to loss to follow-up (LTFU) and treatment interruption (TI) among ovarian cancer patients in Sub-Saharan Africa. Objective: This study aimed to identify sociodemographic and socioeconomic factors associated with LTFU and TI among women receiving treatment for ovarian cancer at Moi Teaching and Referral Hospital (MTRH). Methods: A retrospective study analyzed records of 400 patients diagnosed with ovarian cancer and initiated on treatment in the gynecologic oncology service from January 1, 2015, to December 31, 2022. Data were collected using a researcher- designed questionnaire. The analysis summarized demographic and clinical characteristics. Categorical variables, such as education level, occupation, and marital status, were reported as frequencies and their corresponding percentages. Numerical variables, including age and distance from home to the hospital, were summarized using means/ medians, and their corresponding standard deviations/interquartile ranges. Comparisons were made using Student or Mann-Whitney t-tests and the Pearson Chi-squared test for proportions. The Kruskal-Wallis test was employed for multiple comparisons, with a p-value < 0.05 deemed statistically significant. Results: Patient ages ranged from 6 to 87 years, with a mean of 48.6 ± 15.1 years. Half (51.4%) were aged 40-59 years, and 22.8% were 60 years and above. Most patients (73.9%) were unemployed and married (80.1%), with 90.9% having active health insurance. Rural residents constituted 64.1% of the patients, with travel distances to MTRH ranging from 3 to 850 km (median: 400 km; IQR: 45-150 km). The LTFU rate was 2.995 [95% CI 2.589–3.464] per 100 persons per month. Factors significantly associated with LTFU and TI included age, employment status, marital status, distance to hospital, and type of treatment. Unemployed patients had an odds ratio (OR) of 2.36 (95% CI: 1.22–4.58) for LTFU and TI compared to employed ones. Patients without active health insurance had an OR of 3.94 (95% CI: 2.09–7.41) for being lost to follow-up, while younger patients (<40 years) had an OR of 2.37 (95% CI: 1.16–4.86). Conclusion: Ovarian cancer patients at MTRH face a LTFU rate of 50.6% and a TI rate of 0.8%, influenced by factors such as significant unemployment, economic barriers, a younger age, lack of health insurance, and distance from the hospital. Recommendation: Enhancing health insurance coverage, organizing outreach programs, and implementing awareness campaigns alongside telemedicine initiatives are essential to improve treatment adherence. Qualitative studies are also recommended.