de Fouw Marlieke, Boere Melissa W M, Nakisige Carolyn, Nabwire Mariam, Namugga Jane, Luutu Israel, Orem Jackson, Lith Jan M M van, Beltman Jogchum J
Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Gynaecological Oncology, Uganda Cancer Institute, Kampala, Uganda.
PLoS One. 2025 Jan 9;20(1):e0316323. doi: 10.1371/journal.pone.0316323. eCollection 2025.
Treatment of cervical cancer patients in Uganda is hampered by late diagnosis due to the unavailability of timely screening and limited availability of advanced cancer care. This study evaluated the clinical presentation and management of cervical cancer patients presenting at the Uganda Cancer Institute (UCI) in Kampala, the tertiary oncology facility in Uganda with access to radiotherapy and reflected on daily clinical practice to identify priority areas for improving cervical cancer care in Uganda.
We retrospectively analyzed medical records of all cervical cancer patients presenting to UCI between January 2017 and March 2018 for sociodemographic characteristics and clinical variables with descriptive statistics. The clinical management of patients with early and advanced stage disease who initiated treatment at UCI was evaluated using the national targets formulated in the Uganda strategic plan for cervical cancer prevention and control.
Medical records of 583 patients were included, representing less than 10% of the annual estimated incidence in Uganda. The majority (86%) of patients presented with advanced stage of disease. More than half of patients never initiated (31%) or interrupted (30%) treatment. The national treatment targets for surgery (10%) and palliative care (25%) were achieved for eligible patients at UCI, however, the target for chemoradiotherapy (65%) was not met.
Daily clinical practice differed from the ambitions formulated in the national treatment targets on cervical cancer control. While most women presented in advanced stage requiring chemoradiotherapy, the target was not met due to limited availability of radiotherapy. Although targets for surgery and palliative care were achieved at UCI facility level, they mask the unmet need of the majority of cervical cancer patients who never initiated or completed treatment. This demands for further expansion of oncological surgical capacity, chemotherapy and radiotherapy and warrants to focus on accessible prevention programs.
由于缺乏及时的筛查以及晚期癌症治疗资源有限，乌干达宫颈癌患者的治疗因诊断延迟而受到阻碍。本研究评估了在坎帕拉的乌干达癌症研究所（UCI）就诊的宫颈癌患者的临床表现及治疗情况。UCI是乌干达的三级肿瘤治疗机构，可提供放射治疗。本研究还对日常临床实践进行了反思，以确定改善乌干达宫颈癌治疗的优先领域。
我们回顾性分析了2017年1月至2018年3月期间在UCI就诊的所有宫颈癌患者的病历，以获取社会人口统计学特征和临床变量，并进行描述性统计分析。使用乌干达宫颈癌预防与控制战略计划中制定的国家目标，对在UCI开始治疗的早期和晚期疾病患者的临床治疗情况进行评估。
纳入了583例患者的病历，这一数字不到乌干达年度估计发病率的10%。大多数（86%）患者就诊时已处于疾病晚期。超过一半的患者从未开始（31%）或中断（30%）治疗。UCI符合条件的患者实现了国家手术治疗目标（10%）和姑息治疗目标（25%），然而，放化疗目标（65%）未达成。
日常临床实践与国家宫颈癌控制治疗目标中设定的目标存在差异。虽然大多数女性就诊时处于需要放化疗的晚期，但由于放射治疗资源有限，目标未达成。尽管在UCI机构层面实现了手术和姑息治疗目标，但这掩盖了大多数从未开始或完成治疗的宫颈癌患者未得到满足的需求。这需要进一步扩大肿瘤外科手术能力、化疗和放疗，并值得关注可及的预防项目。
