Survival of Patients With Cervical Cancer at Moi Teaching and Referral Hospital in Eldoret, Western Kenya

Abstract

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.