Department of Oncology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
JCO Glob Oncol. 2023 May;9:e2200435. doi: 10.1200/GO.22.00435.
Nonmetastatic cervical cancer is curable and can be treated with radiotherapy (RT). A delay in receiving treatment because of long waiting times results in upstaging of the disease stage and negatively affects the treatment outcomes. However, real-world evidence that progression occurs while waiting for treatment is scarce in low-income countries. We evaluated the impact of long waiting times for RT in patients with cervical cancer at a referral center in Ethiopia.
A longitudinal study was conducted from January 5, 2019, to May 30, 2020, to address the objectives of this study. Patients with pathologically diagnosed cervical cancer with stage IIB to stage IVA were included in the study. We used Kaplan-Meier analysis to assess overall survival with time. Multivariate Cox regression analysis, using the backward likelihood ratio selection method, was used to fit the final model.
The median waiting time for radical RT after diagnosis was 477 days. Waiting for more than 51 days for RT results in disease progression. Of the 115 patients included in this study, 59 (51.3%) died during the study period. A delay in waiting (adjusted hazard ratio, 3; 95% CI, 1.7 to 4.9) was significantly associated with disease progression and decreased survival.
Waiting time to receive RT is very long. Urgent action is required to significantly reduce waiting times and improve the survival of patients with cervical cancer.
非转移性宫颈癌是可治愈的，可以采用放射治疗（RT）进行治疗。由于等待时间过长而延迟接受治疗会导致疾病分期升级，并对治疗结果产生负面影响。然而，在低收入国家，等待治疗期间疾病进展的实际证据很少。我们评估了在埃塞俄比亚的一个转诊中心，等待 RT 的时间过长对宫颈癌患者的影响。
本研究采用纵向研究方法，从 2019 年 1 月 5 日至 2020 年 5 月 30 日开展研究。本研究纳入了经病理诊断为 IIB 期至 IVA 期的宫颈癌患者。我们使用 Kaplan-Meier 分析评估了生存时间的总体生存率。采用后向似然比选择法的多变量 Cox 回归分析用于拟合最终模型。
诊断后接受根治性 RT 的中位等待时间为 477 天。等待 RT 超过 51 天会导致疾病进展。在这项研究中，共有 115 名患者纳入研究，其中 59 名（51.3%）在研究期间死亡。等待时间的延迟（调整后的危险比为 3；95%CI，1.7 至 4.9）与疾病进展和生存下降显著相关。
等待接受 RT 的时间非常长。需要采取紧急行动，显著缩短等待时间，提高宫颈癌患者的生存率。
