Patient and disease related factors associated with lost-to follow-up/drop-outs of cervical cancer patients: a study at a Major Cancer Hospital in South India.

OBJECTIVE

Cervical cancer is the one of most common cancer in India, and a significant proportion of patients do not complete the prescribed courses of treatment and post therapy surveillance, due to deficiencies in treatment availability, accessibility, affordability and other socio-demographic factors.

MATERIALS AND METHODS

Cervical cancer patient data for the year 2006-2007 were collected during June-August, 2008 from the Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala, India and investigated for socio-economic, demographic and disease (SEDD) related factors impacting patients to drop-out during treatment and patients to loss to follow-up (LFU) post therapy. Odds ratio (OR) for drop-out and LFU and their 95% confidence intervals (CIs) according to SEDD factors were estimated through logistic regression model.

RESULTS

Among a total of 784 patients, 94 (12%) did not complete the initially planned treatment and among 690 cases who had completed the initially planned treatment, 34% were lost to follow up (LFU). In the multivariate analysis, higher chances of LFU for older patients (OR=1.8; 95% CI: 1.1-3.1), widowed/divorced/separated/unmarried (OR=1.5; 95%CI: 1.0-2.1), middle school education (OR=1.8; 95% CI: 1.0-3.1), poorer performance status (OR=2.4; 95% CI: 1.2-5.0) and in higher stages (OR= 4.6; 95% CI: 2.1- 10.3). Higher chances of drop-outs were noted for patients with medium income (OR=2.0; 95% CI: 1.0-4.1), higher stages (OR=4.8; 95% CI: 1.9-12.2) and ischemic heart disease (OR=3.4; 95% CI: 1.1-10.9).

CONCLUSION

Drop-out rates are associated with disease related factors and patients in the LFU group were affected mainly by SEDD factors. Physicians should be aware of patients' different needs in these two different phases, thus improving the retention rate in the near future of cancer treatment.