Predictors of Five-Year Overall Survival in Women Treated for Cervical Cancer at the Kenyatta National Hospital in 2008

Abstract

Cervical cancer is the fourth most commonly diagnosed and the fourth leading cause of cancer death among women worldwide. In many low- and middle-income countries (LMICs) including Kenya cervical cancer remains the leading cause of cancer death among women. This situation is due to the fact that despite the existence of effective preventive and early detection programs, lack of implementation in LMICs leads many women suffering from the disease to premature death. This study was aimed at estimating the five-year overall survival rates for women with cervical cancer in Kenya. To achieve this, the study employed a retrospective cohort design where medical records of all patients who commenced treatment for cervical cancer in 2008 were reviewed retrospectively over a period of five years from 2008- 2013. Data analysis involved the use of Stata v14.2 to generate descriptive statistics and conduct survival analysis. The five-year overall survival estimate for women with cervical cancer at Kenyatta National Hospital (KNH) in 2008 was found to be 59%. Stage of disease at diagnosis, type of treatment received and whether or not treatment was initiated and completed are the three factors revealed to have the strongest influence on patient survival. Occupation which was used as a proxy for socio-economic status (SES) did not reflect the financial burden imposed on patients seeking treatment. However, the loss to follow up was significantly high at a rate of 82.3%; with no deaths observed after the first year, the overall survival estimate is only accurate over the first year. The results of this study provided insight on the relationship between various socio-demographic and clinical factors and patient outcomes of cervical cancer treatments at KNH. Moreover, it highlighted the ongoing health system challenges surrounding provision of and access to cancer treatment. The results will inform policy makers and health service providers on the quality and accessibility of available cervical cancer treatments as delivered within our healthcare setting.