Centre Mohammed VI Pour Le Traitement Des Cancers, Centre Hospitalier Universitaire Ibn Rochd de Casablanca, Casablanca, Maroc.
Registre Des Cancers de La Région du Grand Casablanca, Casablanca, Maroc.
BMC Cancer. 2022 May 2;22(1):479. doi: 10.1186/s12885-022-09358-x.
We conducted a Pattern-of-care (POC) study at two premier-most public-funded oncology centers in Morocco to evaluate delays in care continuum and adherence to internationally accepted treatment guidelines of cervical cancer.
Following a systematic sampling method, cervical cancer patients registered at Centre Mohammed VI (Casablanca) and Institut National d'Oncologie (Rabat) during 2 months of every year from 2008 to 2017, were included in this retrospective study. Relevant information was abstracted from the medical records.
A total of 886 patients was included in the analysis; 59.5% were at stage I/II. No appreciable change in stage distribution was observed over time. Median access and treatment delays were 5.0 months and 2.3 months, respectively without any significant temporal change. Concurrent chemotherapy was administered to 57.7% of the patients receiving radiotherapy. Surgery was performed on 81.2 and 34.8% of stage I and II patients, respectively. A very high proportion (85.7%) of operated patients received post-operative radiation therapy. Median interval between surgery and initiation of radiotherapy was 3.1 months. Only 45.3% of the patients treated with external beam radiation received brachytherapy. Radiotherapy was completed within 10 weeks in 77.4% patients. An overall 5-year disease-free survival (DFS) was observed in 57.5% of the patients - ranging from 66.1% for stage I to 31.1% for stage IV. Addition of brachytherapy to radiation significantly improved survival at all stages. The study has the usual limitations of retrospective record-based studies, which is data incompleteness.
Delays in care continuum need to be further reduced. Increased use of chemoradiation and brachytherapy will improve survival further.
我们在摩洛哥两家首屈一指的公立肿瘤中心进行了一项基于实践的研究，以评估宫颈癌治疗连续体中的延迟和对国际公认的治疗指南的遵循情况。
采用系统抽样方法，从 2008 年至 2017 年，每年在中心 Mohammed VI（卡萨布兰卡）和 Institut National d'Oncologie（拉巴特）登记的宫颈癌患者均纳入本回顾性研究。从病历中提取相关信息。
共纳入 886 例患者进行分析；59.5%处于 I/II 期。随着时间的推移，分期分布没有明显变化。中位获得治疗的延迟时间为 5.0 个月，治疗延迟时间为 2.3 个月，均无明显的时间变化。接受放疗的患者中，57.7%同步接受化疗。I 期和 II 期患者分别有 81.2%和 34.8%接受手术。手术患者中，85.7%接受术后放疗。手术与放疗开始之间的中位间隔为 3.1 个月。仅 45.3%接受外照射放疗的患者接受近距离放疗。77.4%的患者在 10 周内完成放疗。5 年无病生存率（DFS）为 57.5%，从 I 期的 66.1%到 IV 期的 31.1%。在所有分期中，添加近距离放疗可显著改善生存。该研究存在回顾性记录研究的常见局限性，即数据不完整。
需要进一步减少治疗连续体中的延迟。增加放化疗和近距离放疗的使用将进一步提高生存率。
