Retrospective record review of patients diagnosed with endometrial cancer and carcinosarcoma at Rahima Moosa mother and child hospital receiving treatment at Charlotte Maxeke Johannesburg academic hospital

Abstract

Introduction Endometrial cancer is the most common Gynaecological cancer in developed countries, however, in South Africa it is ranked only the eighth highest. Previous research has shown that black women are diagnosed at a younger age, have a higher incidence of type II endometrial cancer and uterine carcinosarcoma and have a worse overall survival than white women. Government hospitals are busy with large numbers of patients seen daily resulting in longer waiting times for patients requiring surgery and adjuvant treatment for cancer. Patients and Methods This was a retrospective cross sectional descriptive study of patients diagnosed with endometrial carcinoma and uterine carcinosarcoma at Rahima Moosa Mother and Child Hospital (RMMCH) between 2009 and 2013. Patient files from both RMMCH and Charlotte Maxeke Johannesburg Hospital (CMJAH) were reviewed. Patients were initially seen at RMMCH, some underwent surgery and they were then referred to CMJAH for adjuvant treatment. Files from both hospitals were reviewed. 55 files were obtained at RMMCH and 50 patients were referred to CMJAH for further treatment. Results The most common histological types of endometrial cancer were low grade adenocarcinoma (34.54%) and uterine carcinosarcoma (25.45%). 56.36% of patients presented with early disease (stage 1/2) and 43.64% with advanced disease (stage 3/4). The overall disease free survival was 75.67% at one year, with 8.10% of patients with metastases and 16.21% of patients having died within one year. 53.70% of patients waited less than 62 days until definitive management with 14.81% who waited for more than six months for surgery. Conclusion We found a high frequency of patients with uterine carcinosarcoma which may account for the low disease free survival at one year after adjuvant treatment together with the fact that a large proportion of our patients present with late stage disease. Our study found long waiting times between presentation and treatment with poor follow up by patients. Improved patient education and counselling together with ‘fast tracking’ of oncology patients may be instrumental in better patient adherence and outcomes.