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.