Clinical profile and immediate outcomes of concurrent chemoradiation for cervical cancer at the Bugando medical centre in Mwanza, Tanzania

Abstract

Background: Globally, cervical cancer poses a challenge to public health. It is the fourth most prevalent cancer diagnosed in women worldwide, with an estimated annual death rate of 311,000. It is currently the most prevalent malignant disease in Tanzania in which the majority of patients with advanced cervical cancer have been offered concurrent chemoradiation (CCR). However, neither the clinical profile nor the immediate outcomes of these patients treated at the Bugando Medical Centre (BMC) have been thoroughly studied.

Methodology: The prospective cohort study was conducted from November 2021 to April 2022, involving 160 eligible patients with histopathologically confirmed cervical cancer who received concurrent chemoradiation at BMC. Patients were followed for seven weeks, with the main clinical profiles of interest being age, histological type, histological tumor grade, FIGO disease stage, and HIV status, and the outcomes of interest being short-term clinical treatment-related toxicity and symptoms disappearance. The history and physical examination provided information about the patient's characteristics. Multivariate Logistic regression analysis was performed to evaluate the strength of the association between the patient's clinical profile and the short-term clinical treatment-related toxicity and symptoms disappearance. P-values less than 0.05 were considered statistically significant.

Results: A total of 160 cervical cancer patients eligible were enrolled, with a median age of 50 years, 117 (73.5%) living in rural areas, and 152 (95%) being illiterate or having only primary education. The most common presenting symptoms were abnormal vaginal discharge 116 (72.5%) and bleeding 111 (69.4%). 119 (74%) patients presented at a late stage (IIB-1VA), 59 (36.9%) were HIV-positive, the majority 134 (83.7%) had squamous cell carcinoma, and 91 (56,2%) had a tumor of grade II type. At week 7, 60% of patients had a complete response to treatment. Vaginal bleeding and discharge improved, with only 12.5% and 6% of women still experiencing these symptoms respectively by week 7 however, 31% of reported cases of low back pain persisted. The majority of patients experienced tolerable grade II toxicities, including diarrhea (58%), vomiting (44.3%), and skin desquamation (52.5%). Fewer study participants reported grade III toxicity, and neither grade IV toxicity nor toxicity-related deaths were reported. Age > 60 years of age (OR 5.58; 95%CI 1.91-16.30; p = 0.002), late tumor stage at presentation (OR 3.36; 95%CI 1.53-7.37; p = 0.002), and HIV seropositivity (OR 11.8; 95%CI 4.87-28.6; p = 0.001) were associated with poor treatment responses.

Conclusion: Cervical cancer still affects the majority of middle-aged women from rural areas with low levels of education and the majority present at an advanced stage. At BMC, concurrent chemoradiation has tolerable toxicity and a promising outcome. Early treatment outcomes are heavily influenced by HIV seropositivity, disease stage, and advanced age.

Keywords: Cervical cancer; Tanzania; chemoradiation; toxicity; treatment outcomes.

Figure 1

Requirement of patients

Figure 2

Distribution of population according to the disappearance of symptoms