A Five-year Review of the Outcomes on the Management of Cancer of the Cervix at Kenyatta National Hospital.

Abstract

Background: Cervical cancer is the leading cause of cancer-related morbidity and mortality among women in sub-Saharan Africa and other developing countries. Kenyatta National Hospital has over the years been the referral centre of choice for many Kenyans for the treatment of cancer of the cervix where different management modalities are offered depending on the stage of the disease. Late diagnosis has limited treatment options and this affects the survival rates. Objective: To determine the outcomes of management of patients with cancer of the cervix at Kenyatta National Hospital: a five-year review. Methodology: A retrospective cohort study was carried out over the five - year period of 2007-2012 to determine the outcomes of management at KNH and document the survival rates for future appraisal in service delivery at the Hospital. The exposures were the 4 arms of treatment in which surgery 81, radiotherapy 81, chemotherapy 60 and combined therapy 87 patients records were reviewed for the treatment modalities respectively and the outcomes of interest were the survival rates. The sampling frame included all patients managed for cervical cancer at Kenyatta National Hospital from July 2007-June 2012 and had a clinical staging and histological diagnosis. Data on patients' demographics, stage at diagnosis, specific management given was collected using standardised data retrieval forms. Two and five-year survival rates were generated. Analysis was done using SPSS®. The study proposal was submitted to the KNH-UoN Ethics and Research Committee for review and approval before being carried out. Results: The age of the participants varied from 23 years to 91 years (mean of 47.76), while the mode was 46 years. Sixty five percent of the participants were between the age group of 35 years and 54 years. Squamous cell carcinoma was the most common histological diagnosis (89.3 %). Adeno carcinoma accounted for 8.4% of the diagnoses. Thirty seven percent of the participants had early stage disease (up to FIGO stage IIa), while 63% of the participants had advanced stage disease (from stage IIb to IVb). Only 132 (42 .7 %) of the participants had recorded tests for HIV infection of whom about 45 % were positive. The overall survival rates were 47.6% and 14.9% at two and five years respectively. The staging of the disease (p <0.001, p =0.001), the mode of treatment (<0.001 (ᵡ2), <0.001 (ᵡ2)) were shown to have an association with the 2 and 5 year survival rates respectively. Conclusion: A total of 309 participants were reviewed for the four treatment arms: Surgery 81, Radiotherapy 81, Chemotherapy 60 and Combined 87. A hundred and fourteen (37%) of the participants had early stage disease (Up to FIGO stage IIa), while 195 (63%) of the participants had advanced stage disease (from stage IIb to IVb). The overall survival rates were 47.6% at two years and 14.9% at 5 years. The study highlights the association of late diagnosis of cervical cancer and survival rate in which the survival was only 31.9 % at 2 years and 3.6% at 5 years for stages IIb to IVb. This compares with 70.1% at 2 years and 51.9% at 5 years for early stage disease (up to stage IIa). The predictors of survival were age at diagnosis, staging of the disease at diagnosis and the mode of treatment offered. Among other recommendations, radiotherapy services in public institutions should be devolved to the counties to reduce delay in initiating treatment after diagnosis and reduce defaulting and loss to follow-up due to distance and cost.