. 2021 May 13:37:100784.

doi: 10.1016/j.gore.2021.100784. eCollection 2021 Aug.

Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

Jane Mwamba Mumba^{1

2}, Lackson Kasonka^{1

3}, Okola Basil Owiti⁴, John Andrew⁴, Mwansa Ketty Lubeya^{1

3}, Lufunda Lukama^{5

6}, Charlotte Kasempa⁷, Susan C Msadabwe^{7

8}, Chester Kalinda^{9

10}

Affiliations

¹ The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia.
² Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia.
³ Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia.
⁴ Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium.
⁵ Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia.
⁶ University of KwaZulu-Natal, College of Health Sciences., Nelson R Mandela School of Medicine, Durban 4001, South Africa.
⁷ Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia.
⁸ Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka, Lusaka.
⁹ University of Namibia, Faculty of Agriculture, Engineering and Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia.
¹⁰ University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa.

PMID: 34095422
PMCID: PMC8165546
DOI: 10.1016/j.gore.2021.100784

Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

Jane Mwamba Mumba et al. Gynecol Oncol Rep. 2021.

. 2021 May 13:37:100784.

doi: 10.1016/j.gore.2021.100784. eCollection 2021 Aug.

Authors

Affiliations

¹ The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia.
² Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia.
³ Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia.
⁴ Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium.
⁵ Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia.
⁶ University of KwaZulu-Natal, College of Health Sciences., Nelson R Mandela School of Medicine, Durban 4001, South Africa.
⁷ Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia.
⁸ Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka, Lusaka.
⁹ University of Namibia, Faculty of Agriculture, Engineering and Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia.
¹⁰ University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa.

PMID: 34095422
PMCID: PMC8165546
DOI: 10.1016/j.gore.2021.100784

Abstract

Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.

Keywords: Cancer Diseases Hospital; Cervical cancer; Public health facility; Screening; Turnaround time.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig 2**
Cancer clinical workflow pathway stages and stage-processes handled at referral facilities (stage 1–2) and the Cancer Diseases hospital (stages 3–6).

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Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

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Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

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Conflict of interest statement

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