Quality of life of patients undergoing surgical treatment for early-stage cervical cancer at two Referral Hospitals in Kenya

Abstract

Background: Cervical cancer is a major cause of death among women globally. In lowand middle‐income countries (LMICs) such as Kenya, it is the second most prevalent cancer among women and the third leading cause of mortality. Currently, there is limited published data on the quality of life (QOL) of women suffering from the disease, especially those treated at the two leading national hospital in Kenya. This is despite the fact that majority of these women receive cervical cancer treatment at Moi Teaching and Referral Hospital (MTRH) and Kenyatta National Hospital (KNH) in Kenya. Furthermore, surgical treatment is a major component in the management of cervical cancer in these facilities. Objective: To determine the quality of life of patient undergoing surgery as treatment for surgically amenable stage of cancer of the cervix at MTRH and KNH. Methods: A prospective cohort study conducted among 71 patients undergoing surgery for surgically amenable cervical cancer stage. Consecutive sampling of women who met the eligibility criteria was used to identify potential participants who underwent a written informed consenting process. The participants were enrolled pre-operatively and an interviewer administered questionnaire used to comprehensively assess the five dimensions of the quality-of-life assessment tool (EQ-5D-5L) namely: mobility, selfcare, ability to perform usual activities, pain or discomfort and depression or anxiety. The overall duration of data collection was seventeen months (October 2019 to February 2021) with each participant followed-up for three months post-operatively. Descriptive statistical techniques were used to describe the study participants while a bivariate analysis technique was used to compare the difference in participant‟s socio demographic and characteristics with a p-value ≤0.05 considered to be statistically significant. Results: The mean age of the study participants was 47.94 (±10.25) years with 66 (93%) of them being married, 37 (52.1%) unemployed and 39 (54.9%) having health insurance. Nearly two-thirds (63.5%) of the women enrolled had a parity of four or more, 69 (97.2%) did not have a family history of cervical cancer, none reported a history of cigarette smoking while 57 (80.3) were negative to human immunodeficiency virus (HIV) test. Most women (47.9%) had Stage 1 B2 of cervical cancer followed by those with stage 1 B1 seen in 28 (39.4%) of the women enrolled. There were statistically significant differences in pain/discomfort (p=0.028) and anxiety/ depression (p=0.028). Patients aged 20-35 years had a two-fold increased likelihood (AOR=2.44; 95% CI: 1.30, 3.10; p=0.011) of reporting better quality of life scores compared to older women. The lower the cervical cancer stage (Stage 1 A2), the higher the likelihood for improved quality of life following surgical management of cervical cancer (AOR=5.69; 95% CI: 3.55, 6.89; p=0.001). Conclusion: This study reports that being aged 20-35 years old and having a lower cervical cancer stage were the socio demographic and clinical factors that increased the likelihood of a good quality of life outcome following surgical management of cervical cancer. The statistically significant differences in the quality of life following radical hysterectomy were on pain and anxiety levels reduction. Recommendation: More attention and clinical focus should be offered to cervical cancer patients who are elderly and with advanced cervical stages to improve their quality of life quality of life by focusing more on addressing their pain/ discomfort and anxiety/depression.