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Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Cervical Cancer | Research

Treatment compliance among adult cervical cancer patients receiving care at Uganda cancer institute, Uganda: a retrospective data review

Authors: Josephine Irene Najjemba, Regina Ndagire, Pius Mulamira, Solomon Kibudde, Catherine Nassozi Lwanira

Published in: BMC Cancer | Issue 1/2023

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Abstract

Background

Cervical cancer is one of the most common cancers and a major cause of morbidity among women globally. Chemoradiation therapy is the preferred standard treatment for women with stage IB to IVA. However, the benefits of this treatment can only be achieved if patients adhere to the treatment guidelines. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at Uganda Cancer Institute (UCI) was determined.

Methods

This was a cross-sectional study that reviewed data retrospectively for 196 cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB to IVA. Patient data and information on treatment uptake was obtained by review of the patient’s medical records. Treatment compliance was determined by calculating the number of participants who completed the prescribed treatment (definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy with weekly concurrent cisplatin followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks). Associations between patient factors and treatment adherence were determined using logistic regression analysis. In all statistical tests, a P- value of < 0.05 was considered as significant.

Results

The proportion of patients who were administered with external beam radiation (EBRT), chemotherapy and brachytherapy were 82.6%, 52.04% and 66.2% respectively. However, only 23 of 196 patients (11.7%) were found to have adhered to the treatment plan by completion of all definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy (5 weeks) with weekly concurrent cisplatin (5 cycles) followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks (3 sessions). There were no significant associations between patient factors and treatment adherence after multivariable analysis.

Conclusions

Treatment compliance was found in only 12% of the cohort participants. No association of patient factors with treatment compliance was found. Additional studies on treatment adherence with larger sample sizes are needed to confirm the associations.
Literature
1.
go back to reference Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209–49. CrossRef Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209–49. CrossRef
2.
go back to reference World Health Organization. Global Cancer Observatory report, 2021. World Health Organization. Global Cancer Observatory report, 2021.
3.
go back to reference Asasira J, Lee S, Tran TXM, Mpamani C, Wabinga H, Jung S-Y, Chang YJ, Park Y, Cho H. Infection-related and lifestyle-related cancer burden in Kampala, Uganda: projection of the future cancer incidence up to 2030. BMJ open. 2022;12(3):e056722.CrossRefPubMedPubMedCentral Asasira J, Lee S, Tran TXM, Mpamani C, Wabinga H, Jung S-Y, Chang YJ, Park Y, Cho H. Infection-related and lifestyle-related cancer burden in Kampala, Uganda: projection of the future cancer incidence up to 2030. BMJ open. 2022;12(3):e056722.CrossRefPubMedPubMedCentral
5.
go back to reference Chuang LT, Feldman S, Nakisige C, Temin S, Berek JS. Management and care of women with invasive cervical cancer: ASCO resource-stratified clinical practice guideline. J Clin oncology: official J Am Soc Clin Oncol. 2016;34(27):3354–5.CrossRef Chuang LT, Feldman S, Nakisige C, Temin S, Berek JS. Management and care of women with invasive cervical cancer: ASCO resource-stratified clinical practice guideline. J Clin oncology: official J Am Soc Clin Oncol. 2016;34(27):3354–5.CrossRef
6.
go back to reference Singotia L, Jain RK, Panihar C, Rawat S, Raj A. Integration of Chemotherapy with Brachytherapy in the treatment of locally Advanced Uterine Cervical Cancer. J Cancer Sci Therapy. 2021;13:6. Singotia L, Jain RK, Panihar C, Rawat S, Raj A. Integration of Chemotherapy with Brachytherapy in the treatment of locally Advanced Uterine Cervical Cancer. J Cancer Sci Therapy. 2021;13:6.
7.
go back to reference Putri NQ, Permata TBM, Wulandari NA, Handoko, Nuryadi E, Purwoto G, Gondhowiardjo SA. Relationship of adherence to Cervical Cancer Treatment Guideline towards Patients’ five-year Survival: systematic review of follow-up trials. Cancer Manag Res. 2020;12:12649–55.CrossRefPubMedPubMedCentral Putri NQ, Permata TBM, Wulandari NA, Handoko, Nuryadi E, Purwoto G, Gondhowiardjo SA. Relationship of adherence to Cervical Cancer Treatment Guideline towards Patients’ five-year Survival: systematic review of follow-up trials. Cancer Manag Res. 2020;12:12649–55.CrossRefPubMedPubMedCentral
8.
go back to reference Zamorano AS, Barnoya J, Gharzouzi E, Chrisman Robbins C, Orozco E, Polo Guerra S, Mutch DG. Treatment compliance as a major barrier to optimal cervical Cancer treatment in Guatemala. J Glob Oncol. 2019;5:1–5.PubMed Zamorano AS, Barnoya J, Gharzouzi E, Chrisman Robbins C, Orozco E, Polo Guerra S, Mutch DG. Treatment compliance as a major barrier to optimal cervical Cancer treatment in Guatemala. J Glob Oncol. 2019;5:1–5.PubMed
9.
go back to reference Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.CrossRefPubMed Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.CrossRefPubMed
10.
go back to reference Moelle U, Mathewos A, Aynalem A, Wondemagegnehu T, Yonas B, Begoihn M, Addissie A, Unverzagt S, Jemal A, Thomssen C, et al. Cervical Cancer in Ethiopia: the Effect of Adherence to Radiotherapy on Survival. Oncologist. 2018;23(9):1024–32.CrossRefPubMedPubMedCentral Moelle U, Mathewos A, Aynalem A, Wondemagegnehu T, Yonas B, Begoihn M, Addissie A, Unverzagt S, Jemal A, Thomssen C, et al. Cervical Cancer in Ethiopia: the Effect of Adherence to Radiotherapy on Survival. Oncologist. 2018;23(9):1024–32.CrossRefPubMedPubMedCentral
11.
go back to reference Iyoke CA, Ugwu GO, Ezugwu EC, Ezugwu FO, Lawani OL, Onyebuchi AK. Challenges associated with the management of gynecological cancers in a tertiary hospital in South East Nigeria. Int J Womens Health. 2014;6:123–30.CrossRefPubMedPubMedCentral Iyoke CA, Ugwu GO, Ezugwu EC, Ezugwu FO, Lawani OL, Onyebuchi AK. Challenges associated with the management of gynecological cancers in a tertiary hospital in South East Nigeria. Int J Womens Health. 2014;6:123–30.CrossRefPubMedPubMedCentral
12.
go back to reference Eze JN, Emeka-Irem EN, Edegbe FO. A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria. Clin Med Insights Oncol. 2013;7:151–8.CrossRefPubMedPubMedCentral Eze JN, Emeka-Irem EN, Edegbe FO. A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria. Clin Med Insights Oncol. 2013;7:151–8.CrossRefPubMedPubMedCentral
14.
go back to reference Kibudde S, Namisango E, Nakaganda A, Atieno M, Bbaale J, Nabwana M, Kiyange F, O’brien M, Luyirika EB, Orem J. Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study. Afr Health Sci. 2022;22(1):327–37.CrossRefPubMedPubMedCentral Kibudde S, Namisango E, Nakaganda A, Atieno M, Bbaale J, Nabwana M, Kiyange F, O’brien M, Luyirika EB, Orem J. Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study. Afr Health Sci. 2022;22(1):327–37.CrossRefPubMedPubMedCentral
15.
go back to reference Degu A, Njogu P, Weru I, Karimi P. Assessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya. Gynecol Oncol Res Pract. 2017;4:15.CrossRefPubMedPubMedCentral Degu A, Njogu P, Weru I, Karimi P. Assessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya. Gynecol Oncol Res Pract. 2017;4:15.CrossRefPubMedPubMedCentral
16.
go back to reference Gebre Y, Zemene A, Fantahun A, Aga F. Assessment of treatment compliance and associated factors among cervical cancer patients in Tikur Anbessa specialized hospital, oncology unit, Ethiopia 2012. Int J Cancer Stud Res. 2015;4(2):67–74. Gebre Y, Zemene A, Fantahun A, Aga F. Assessment of treatment compliance and associated factors among cervical cancer patients in Tikur Anbessa specialized hospital, oncology unit, Ethiopia 2012. Int J Cancer Stud Res. 2015;4(2):67–74.
17.
go back to reference Habinshuti P, Hagenimana M, Nguyen C, Park PH, Mpunga T, Shulman LN, Fehr A, Rukundo G, Bigirimana JB, Teeple S, et al. Factors Associated with loss to follow-up among cervical Cancer patients in Rwanda. Ann Glob Health. 2020;86(1):117.CrossRefPubMedPubMedCentral Habinshuti P, Hagenimana M, Nguyen C, Park PH, Mpunga T, Shulman LN, Fehr A, Rukundo G, Bigirimana JB, Teeple S, et al. Factors Associated with loss to follow-up among cervical Cancer patients in Rwanda. Ann Glob Health. 2020;86(1):117.CrossRefPubMedPubMedCentral
18.
go back to reference Park PH, Davey S, Fehr AE, Butonzi J, Shyirambere C, Hategekimana V, Bigirimana JB, Borg R, Uwizeye R, Tapela N, et al. Patient characteristics, early outcomes, and implementation Lessons of Cervical Cancer Treatment Services in Rural Rwanda. J Glob Oncol. 2018;4:1–11.PubMed Park PH, Davey S, Fehr AE, Butonzi J, Shyirambere C, Hategekimana V, Bigirimana JB, Borg R, Uwizeye R, Tapela N, et al. Patient characteristics, early outcomes, and implementation Lessons of Cervical Cancer Treatment Services in Rural Rwanda. J Glob Oncol. 2018;4:1–11.PubMed
19.
go back to reference Parveen S, Sajjad R, Masood M, Usmani HA, Sadiq R, Yunus N, Asghar S. Cervical cancer: outcome of treatment and causes of failure. J Pak Med Assoc. 2006;56(10):436–40.PubMed Parveen S, Sajjad R, Masood M, Usmani HA, Sadiq R, Yunus N, Asghar S. Cervical cancer: outcome of treatment and causes of failure. J Pak Med Assoc. 2006;56(10):436–40.PubMed
21.
go back to reference LaVigne AW, Triedman SA, Randall TC, Trimble EL, Viswanathan AN. Cervical cancer in low and middle income countries: addressing barriers to radiotherapy delivery. Gynecol Oncol Rep. 2017;22:16–20.CrossRefPubMedPubMedCentral LaVigne AW, Triedman SA, Randall TC, Trimble EL, Viswanathan AN. Cervical cancer in low and middle income countries: addressing barriers to radiotherapy delivery. Gynecol Oncol Rep. 2017;22:16–20.CrossRefPubMedPubMedCentral
22.
go back to reference National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Cervical Cancer (NCCN Guidelines). Version 4. 2019. National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Cervical Cancer (NCCN Guidelines). Version 4. 2019.
23.
go back to reference Dutta S, Biswas N, Muhkherjee G. Evaluation of Socio-demographic factors for non-compliance to treatment in locally advanced cases of Cancer Cervix in a Rural Medical College Hospital in India. Indian J Palliat Care. 2013;19(3):158–65.CrossRefPubMedPubMedCentral Dutta S, Biswas N, Muhkherjee G. Evaluation of Socio-demographic factors for non-compliance to treatment in locally advanced cases of Cancer Cervix in a Rural Medical College Hospital in India. Indian J Palliat Care. 2013;19(3):158–65.CrossRefPubMedPubMedCentral
24.
go back to reference Yamane T. Statistics An introductory analysis. 2nd ed. New York: Harper and Row; 1967. Yamane T. Statistics An introductory analysis. 2nd ed. New York: Harper and Row; 1967.
25.
go back to reference Nakaganda A, Solt K, Kwagonza L, Driscoll D, Kampi R, Orem J. Challenges faced by cancer patients in Uganda: implications for health systems strengthening in resource limited settings. J Cancer Policy. 2021;27:100263.CrossRefPubMed Nakaganda A, Solt K, Kwagonza L, Driscoll D, Kampi R, Orem J. Challenges faced by cancer patients in Uganda: implications for health systems strengthening in resource limited settings. J Cancer Policy. 2021;27:100263.CrossRefPubMed
26.
go back to reference Pfaendler KS, Chang J, Ziogas A, Bristow RE, Penner KR. Disparities in adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California. Obstet Gynecol. 2018;131(5):899–908.CrossRefPubMedPubMedCentral Pfaendler KS, Chang J, Ziogas A, Bristow RE, Penner KR. Disparities in adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California. Obstet Gynecol. 2018;131(5):899–908.CrossRefPubMedPubMedCentral
27.
go back to reference Boyce-Fappiano D, Nguyen KA, Gjyshi O, Manzar G, Abana CO, Klopp AH, Kamrava M, Orio PF 3rd, Thaker NG, Mourtada F, et al. Socioeconomic and racial determinants of Brachytherapy utilization for cervical Cancer: concerns for widening disparities. JCO Oncol Pract. 2021;17(12):e1958–67.CrossRefPubMedPubMedCentral Boyce-Fappiano D, Nguyen KA, Gjyshi O, Manzar G, Abana CO, Klopp AH, Kamrava M, Orio PF 3rd, Thaker NG, Mourtada F, et al. Socioeconomic and racial determinants of Brachytherapy utilization for cervical Cancer: concerns for widening disparities. JCO Oncol Pract. 2021;17(12):e1958–67.CrossRefPubMedPubMedCentral
28.
go back to reference Chiew KL, Chong S, Duggan KJ, Kaadan N, Vinod SK. Assessing guideline adherence and patient outcomes in cervical cancer. Asia Pac J Clin Oncol. 2017;13(5):e373–80.CrossRefPubMed Chiew KL, Chong S, Duggan KJ, Kaadan N, Vinod SK. Assessing guideline adherence and patient outcomes in cervical cancer. Asia Pac J Clin Oncol. 2017;13(5):e373–80.CrossRefPubMed
29.
go back to reference Levinson KL, Riedel DJ, Ojalvo LS, Chan W, Angarita AM, Fader AN, Rositch AF. Gynecologic cancer in HIV-infected women: treatment and outcomes in a multi-institutional cohort. AIDS. 2018;32(2):171–7.CrossRefPubMed Levinson KL, Riedel DJ, Ojalvo LS, Chan W, Angarita AM, Fader AN, Rositch AF. Gynecologic cancer in HIV-infected women: treatment and outcomes in a multi-institutional cohort. AIDS. 2018;32(2):171–7.CrossRefPubMed
Metadata
Title
Treatment compliance among adult cervical cancer patients receiving care at Uganda cancer institute, Uganda: a retrospective data review
Authors
Josephine Irene Najjemba
Regina Ndagire
Pius Mulamira
Solomon Kibudde
Catherine Nassozi Lwanira
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-11145-1

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