Cervical cancer patients presentation and survival in the only oncology referral hospital, Ethiopia: a retrospective cohort study

Muluken Gizaw; Adamu Addissie; Sefonias Getachew; Wondimu Ayele; Israel Mitiku; Ulrike Moelle; Tigist Yusuf; Mathias Begoihn; Mathewos Assefa; Ahmedin Jemal; Eva Johanna Kantelhardt

doi:10.1186/s13027-017-0171-4

Cervical cancer patients presentation and survival in the only oncology referral hospital, Ethiopia: a retrospective cohort study

Infect Agent Cancer. 2017 Nov 29:12:61. doi: 10.1186/s13027-017-0171-4. eCollection 2017.

Authors

Muluken Gizaw^{1

2}, Adamu Addissie², Sefonias Getachew^{1

2}, Wondimu Ayele^{1

2}, Israel Mitiku³, Ulrike Moelle⁴, Tigist Yusuf², Mathias Begoihn⁴, Mathewos Assefa⁵, Ahmedin Jemal⁶, Eva Johanna Kantelhardt^{1

4}

Affiliations

¹ Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.
² Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
³ Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
⁴ Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany.
⁵ Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
⁶ Department of Intramural Research, American Cancer Society, Atlanta, GA USA.

Abstract

Background: Women infected with Human Immune Deficiency Virus (HIV) are assumed to be at higher risk of developing Cervical Cancer (CC). This is due to a rapid progression of pre-invasive to invasive lesions. However, evidences suggest, due to the availability of antiretroviral therapy (ART) and care services; an improved survival and treatment outcome of CC patients (CCPs) with HIV infection is expected.

Objective: The aim of this study is to examine the clinical characteristics and survival of of CCPs registered at the radiotherapy center of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa University, Ethiopia.

Methods: We conducted a retrospective cohort study. Data from 1655 CCPs diagnosed between September 2008 and September 2012 were included. The primary endpoint was death from any cause. Kaplan-Meier estimates were compared using the log-rank test. Cox proportional hazards regression model was used to identify predictors of death. Data were analyzed using STATA version IC/14.

Results: The mean age of all patients was 49 years (SD = 11.6 years). Of all CCPs, 139 (8.4%) were HIV positive, 372 (22.5%) patients had a known negative HIV status and 1144 (69.1%) patients were asymptomatic with unknown HIV status. Due to late stage and waiting times, only 13.5% of the patients received curative radiotherapy doses. HIV-positive CCPs presented more often with advanced disease compared to HIV negative CCPs ((44.6%) versus 39.7%, p = 0.007). There was no significant difference in survival between HIV-positive and HIV-negative CCPs. Older age (HR = 2.01; 95% CI, 1.01,-4.05), advanced disease (HR = 2.6; 95% CI, 1.67-4.04) and baseline anemia (HR = 1.65; 95% CI, 1.24, 2.20) were independent predictors for higher risk of death.

Conclusion: Survival rates of CCPs did not differ according to HIV status. The risk of death was higher for patients with older age, advanced disease and anemia. HIV patients should be screened for CC according to guidelines to avoid late presentation.

Keywords: Africa; Ethiopia; HIV; Survival; Uterine cervical neoplasms.