Barriers to Timely Initiation and Completion of Guideline Concordance Treatment for Patients With Carcinoma of the Cervix Stage 1b2-iva at Cancer Treatment Centre, Kenyatta National Hospital

Abstract

Background. Cervical carcinoma is the second most common cancer among women in Kenya, with an incidence of 2454 per year according to Globocan 2020. Most patients (80.5%) present with locally advanced form of carcinoma of the cervix. The standard treatment paradigm involves chemo-radiotherapy and brachytherapy delivered in less than 56 days. Exceeding this time period has been associated with poor local control of the disease and poor disease specific survival. Studies assessing the treatment timing patterns have observed that less than 50% of the patients complete treatment within the 56 days. A combination of patient, and system related factors seem to affect the overall treatment timings. Justification for the study Although studies have shown that the total time taken to complete treatment in locally advanced cervical carcinoma affects treatment outcomes, no study in Kenya has yet evaluated the treatment timing patterns in patients with this disease and the factors affecting these patterns. This study sought to shed some light on this topic and identify areas of improvement in the treatment of these patients. Study design The study was a retrospective analytical study analyzing the treatment timing patterns for patients with cervical carcinoma stage Ib2-IVA treated at the cancer treatment center (KNH) between January 2016- December 2020. A structured questionnaire was used to excerpt data from randomly sampled patient files and uploaded to Excel for cleaning and subsequently SPSS for analysis. Descriptive analysis was grouped into continuous and categorical variables, with categorical variables analyzed using frequencies and percentage. Continuous variables were 2 analyzed using mean and median. Inferential analysis was using univariate, bivariate and multivariate analysis. Data findings The median treatment starting time was 71 days with 58.5% of the patients starting their treatment within ninenty days of a histologically confirmed diagnosis. Being employed and having a residence outside Nairobi positively influenced treatment starting times whereas longer duration of symptoms negatively influenced treatment starting times. The median definitive treatment time was 80 days, with 34.5% of the patients completing their treatment within the guideline concordance period of 56 days. Having a secondary or higher education and having residence outside Nairobi positively influenced definitive treatment timelines. Study limitations Considering that the study was retrospective in design, some qualitative data was found to be missing from patient files or was poorly and inconsistently recorded and could not be traced. Consequent to this, variables such as treatment related factors, logistical administrative factors, did not reach the statistical threshold for meaningful analysis and thus were excluded from the final analysis. Recommendations 3 ● Extension of patient navigation program to the point of histological diagnosis can be used in an attempt to shorten the treatment initiation timelines. ● Prospective qualitative studies should be done to identify actionable qualitative factors influencing these timelines for example treatment related factors. ● Prospective multicenter studies should be done to audit the treatment timelines given that the number of public facilities offering cancer treatment (radiotherapy and brachytherapy) have increased from one (during the study period) to five currently. ● Institute proper and comprehensive documentation in the medical informatics to avoid loss of qualitative data that can be used in medical audits to better healthcare through policy changes