Prevalence of Uterine Cervical Cancer Progressive and Persistent Disease among Patients Treated with Chemo-radiation at Ocean Road Cancer Institute

Abstract

Background: Uterine cervical cancer is the second most commonly diagnosed cancer and third leading cause of cancer death among women in less developed countries. It remains the most common cancer of public health concern in women in Eastern and Middle Africa, Tanzania inclusive. At Ocean Road Cancer Institute (ORCI), it is the leading diagnosis for all malignancies. Though progressive and persistent cancer of cervix post treatment is a major problem at the Institute, exact data on the trends is desperately needed. Objective: To determine prevalence of progressive and persistent cervical cancer disease among patients treated with chemo-radiation at Ocean Road Cancer Institute (ORCI). Materials and methods: A descriptive cross-sectional study was conducted among patients received treatment from January through December 2014 at ORCI based in Dar es Salaam. Two-hundred thirty-nine women with uterine cervical cancer disease meeting the predetermined inclusion criteria were included in the study. Retrospective secondary data obtained from the patients’ medical files included socio-demographic profile, clinical profile, pre-treatment assessment as well as 3months and six months post treatment were filled into a well-structured data collection form, and were compiled and analyzed using statistical package for social sciences (SPSS) software version 21. Socio-demographic and clinical factors were analyzed by using frequency and percentage as well as mean and standard deviation. The univariate and multivariate regression analysis were performed to determine the association between dependent variables and independent variables. An association was regarded as statistical significance when the p-value was less than the significance level of 0.05 i.e. P < 0.05. Results: About half of the 239 patients studied were 45-67 years old and 34.7% came from the coastal zone. Approximately, 68.2% patients were referred to ORCI with International Federation of Gynecologist and Obstetric (FIGO) disease stage IIB-IIIB. Among patients studied, progressive disease was seen in 43(18%) patients while persistent disease was observed in 111(46.4%) patients. Progressive disease rate was statistically significantly associated with disease stage (p=0.001), Hb level before therapy (p=0.001)and time taken from the diagnosis of the patient to initiation of therapy (p=0.021). Moreover, mid-therapy Hb level of less than 9gm/dl (p=<0.0001), overall treatment time of more than eight weeks (p=<0.0001), the use of weekly concurrent chemo-radiation (p=<0.0001) and increased time taken from the diagnosis to initiation of radiotherapy (p=<0.0001) were the main factors that contributed to the development of persistence disease for cervical cancer patients received chemo radiation during the stated period. Conclusions and recommendations: This study found that progressive disease had significant association with increased waiting time from the diagnosis of the patient to initiation of therapy and advanced disease stage. Moreover, Persistent disease had significant association with increased waiting time from the diagnosis of the patient to initiation of therapy, lower level of mid-therapy hemoglobin and use of concurrent chemo radiation. Due to high rate of progressive disease found, this can be addressed by early diagnosis and referral to consultant hospital, as well as improving infrastructure and equipments used for cancer treatment. However the prevalence of persistent disease can be intervened by correction of anemia during the course of the therapy, use of concurrent chemo radiation, and giving adequate doses in a proper time.