Outcome of patients with cervical cancer referred for treatment at Charlotte Maxeke Johannesburg Academic Hospital from Far East Rand Hospital

Kalonji, Sylvain
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Introduction and Background: Cervical cancer is a common malignancy worldwide and in South Africa. It remains a burden in developing countries (where 80% of cases are diagnosed) in terms of adequate screening programs, diagnosis and appropriate treatment. Patients with cervical cancer are treated in specialized cancer centers; therefore referring patients from one center to another can present with various challenges that need to be looked at. In our study, we have described various aspects of patients with cervical cancer referred from Far East Rand Hospital (FERH) to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH); we have described the stages of the disease, the time spent from presentation to histology diagnosis/referral/and treatments; we have also looked at the treatment related complications and the overall outcomes at 1 year follow up post treatment. Methods: This was a retrospective cross-sectional descriptive study. We selected patients with cervical cancer from January 2012 to December 2016; patients were initially seen at FERH then referred to CMJAH for continuation of care after histology confirmation of the disease. 40 patient’s files were retrieved at FERH and only 33 files were found at CMJAH; 7 patient’s file did not meet our inclusion criteria hence we excluded them from the study. One year follow up after treatment initiation was done. Results: All our 33 patients (100%) had cervical squamous cell carcinoma. Two patients (6.1%) were at stage IB, 11 patients (33.3%) at stage IIB, 3 patients (9.1%) at stage IIIA, 11 patients (33.3%) at stage IIIB, 4 patients (12.1%) at stage IVA, and 2 patients (6.1%) at stage IVB. The median time interval from Pap smear to treatment initiation (in days) was as follow: 17days(IQR 5-138) from Pap smear to cervical biopsy, 42 days(IQR 33-65) from biopsy to histology results, 7 days(IQR 0-23) from biopsy results to CMJAH referral, 2days(IQR 0-17) from referral to CMJAH to date seen at CMJAH, 7days(IQR 0-22) from CMJAH visit to date seen at radiation oncology unit, 52 days(IQR 37-79) from radiation oncology to treatment initiation. Two patients (6.06%) had surgery plus vault radiotherapy, 22 patients (66.67%) had radiotherapy, 7 patients (21.21%) had chemoradiation, and 4 patients (12.1%) had palliative treatment. Overall, 2 patients (6.06%) died, 7 patients (21.21%) had palliative care, 1 patient (3.03%) had cancer recurrence, 12 patients (36.34%) had cancer remission in the 1styear of follow up, and11 patients (33.33%) were lost to follow up after radiotherapy. Discussion: We have noted that the vast majority of our patients (31 out of 33) presented with advanced disease at the initial visit; this is a similar finding with other studies done in South Africa but different in developed countries where there is adequate screening services. The median waiting times from final histology diagnosis to treatment were very long; this is also found in some studies done in other developing countries but very different to the turnaround time from diagnosis to treatment in developed countries where infrastructures and human resources are adequate. Conclusion: When diagnosed at early stage, cervical cancer can be treated and cured. Most of our patients presented with advanced disease hence did not qualify for surgery as treatment modality. Our study also identified excessive delays from diagnosis to referral/treatment. The number of patients requiring chemo radiation, radiotherapy and palliative care was higher than those requiring surgery for treatment
A research report submitted to the Faculty of Hearth Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters in Medicine (MMed), 2021