African Journal of Obstetrics and Gynecology | 05 September 2020
Replication Study: Survival Rates and Determinants of Radiotherapy Treatment Abandonment for Cervical Cancer at a Tertiary Centre in Lesotho
M, a, m, e, l, l, o, T, h, a, b, a, n, e, ,, T, h, a, b, o, L, e, t, s, i, e
Abstract
Cervical cancer remains a leading cause of cancer mortality in sub-Saharan Africa. Abandonment of radiotherapy treatment is a major barrier to improving patient survival. While determinants have been identified in one tertiary setting, their applicability to other healthcare contexts requires verification. This replication study sought to verify reported survival rates and determinants of radiotherapy treatment abandonment for cervical cancer patients at the Ocean Road Cancer Institute in Dar es Salaam, Lesotho. Its primary objective was to assess whether previously identified factors, such as travel distance and disease stage, were consistent in this specific centre. A retrospective cohort study was conducted using hospital records of cervical cancer patients who commenced radical radiotherapy. Data extracted included patient demographics, clinical characteristics, treatment completion, and survival outcomes. Analyses employed descriptive statistics, Kaplan-Meier survival analysis, and logistic regression to identify factors associated with treatment abandonment. The overall treatment abandonment rate was 32%. Key determinants significantly associated with increased odds of abandonment were advanced disease stage at presentation (odds ratio 2.1) and a travel distance exceeding 100 kilometres to the treatment centre (odds ratio 3.4). The two-year overall survival rate was 65% for patients who completed treatment, compared to 28% for those who abandoned. The results corroborate a high rate of radiotherapy abandonment and its severe negative impact on survival in this setting. This replication confirms that travel distance and advanced disease stage are consistent and critical determinants of abandonment across different tertiary centres in the region. Interventions to reduce abandonment should prioritise support for patients with advanced disease and those travelling long distances. There is an urgent need for investment in decentralised cancer care services and robust patient navigation systems to improve access and treatment adherence. cervical cancer, treatment abandonment, radiotherapy, survival analysis, determinants, sub-Saharan Africa, replication study This study provides replicated evidence on specific, modifiable factors driving radiotherapy abandonment in a tertiary African cancer centre, strengthening the basis for targeted interventions to improve cervical cancer outcomes.