Abstract:
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Abstract
Background
Cervical cancer is a major health burden and the second most common cancer after breast cancer among
women in Kenya. Worldwide, cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are
greatest in low-income countries owing to a lack of awareness, screening and early-detection programs,
and adequate treatment facilities. We aimed to estimate survival rates and determine survival predictors
among women with cervical cancer and limited resources in western Kenya.Methods
We retrospectively reviewed the charts of women diagnosed with cervical cancer in the 2 years from the
date of histologic diagnosis. The outcome of interest was 2-year mortality or survival. Kaplan–Meier
survival estimates, log-rank tests, and Cox proportional hazards regression were used in the survival
analysis.Results
We included 162 women in this study. The median time from diagnosis to death was 0.8 (interquartile
range [IQR] 0.3–1.6) years. The mean age at diagnosis was 50.6 (standard deviation [SD] 12.5) years.
Mean parity was 5.9 (SD 2.6). Participants were followed up for 152.6 person-years. Of 162 women, 70
(43.2%) died, with an overall mortality rate of 45.9 deaths per 100 person-years of follow-up. The survival
rate was significantly better for women who were managed surgically (0.44 vs. 0.88, p < 0.001), those
who had medical insurance (0.70 vs. 0.48, p = 0.007), and those with early-stage disease at diagnosis
(0.88 vs. 0.39, p < 0.001). Participants who were diagnosed at a late stage of disease, according to
International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging (FIGO stage IIB–
IVB), had more than an eight times increased risk of death compared with those who were diagnosed at
early stages (I–IIA): hazard ratio (HR) 8.01 (95% confidence interval [CI] 3.65–17.57). Similarly, women
who underwent surgical management had an 84% reduced risk of mortality compared with those who
were referred for other modes of care: HR 0.16 (95% CI 0.07–0.38).Conclusion
As described in this study, the survival rate of patients with cervical cancer in Kenya is low. Many women
are still diagnosed with cervical cancer when they are at very advanced stages and their likelihood of
survival is very low. It is imperative to expand screening for early identification of women with cervical
cancer in whom surgery can improve prognosis.