Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Int J Cancer. 2021 Sep 15;149(6):1284-1289. doi: 10.1002/ijc.33689. Epub 2021 Jun 22.
There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR = 60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.
在包括埃塞俄比亚在内的低收入国家，放射治疗设备短缺。然而，关于这对癌症结果的不良影响的数据有限。在此，我们根据一项在亚的斯亚贝巴诊断为 IA-IVA 期宫颈癌并计划在该国唯一提供放射治疗服务的提克里安贝萨专科医院接受放射治疗的妇女的前瞻性队列研究，检查了放射治疗的等待时间及其与疾病进展的关联。使用多变量混合效应逻辑回归模型检查关联。在 178 名计划接受放射治疗且有生命状态信息的宫颈癌妇女中，有 16 人（9.0%）在等待放射治疗时死亡。对于其余 162 名开始接受放射治疗的妇女，中位治疗等待期为 137 天（IQR=60-234 天），其中 74.1%的妇女等待时间超过 60 天。这些妇女中有 44.4%的肿瘤进展到更高的阶段。与那些在诊断确认后≤60 天开始放射治疗的妇女相比，那些在 120-179 天（aOR=3.30，95%CI：1.18-9.27）和≥180 天（aOR=3.06，95%CI：1.24-7.52）开始放射治疗的妇女肿瘤进展到更高阶段的可能性要高出三倍。亚的斯亚贝巴宫颈癌妇女接受放射治疗的等待时间非常长，并且与疾病向更高阶段进展有关。这些发现强调需要扩大放射治疗基础设施，以减轻埃塞俄比亚和非洲其他地区疾病的过高负担。
