Clinical Outcomes And Quality Metrics Of Cervical Cancer Treatment In Rwanda

Abstract Purpose: Cervical cancer is a leading cause of cancer-related mortality in Africa. As treatment capacity expands, it is critical to evaluate outcomes and identify targets for quality improvement. We describe a cohort of cervical cancer patients at Butaro Cancer Center (BCCOE) in rural Rwanda, many co-managed by gynecologic specialists at the national referral hospital and a subset referred for definitive chemoradiotherapy plus brachytherapy (CRT) in Nairobi based on available funds and estimated curability. Methosd: We conducted a retrospective cohort study of all patients with cervical cancer seen at BCCOE between 6/2016 and 6/2018. Data were extracted from clinical charts and analyzed using descriptive statistics and Kaplan Meier method. Results: 377 patients were included; median age 54 years, 21% HIV positive. Most patients (85%) had squamous cell carcinoma. A majority (67%) had stage III or IV disease at presentation. Several early stage patients underwent radical hysterectomy (n=34). 114 (30%) received CRT, representing 45% of eligible candidates. Of these, 30 (26%) received upfront CRT after a median 126 days from diagnosis, and 83 (73%) received “temporizing” carboplatin/paclitaxel while awaiting CRT, with a median 56 days from diagnosis to chemotherapy. Patients sent for upfront CRT were younger (p <0.001) and more likely stage II (p <0.001). Nevertheless, there was no survival difference between upfront CRT versus temporizing chemotherapy before CRT. Most chemotherapy recipients (77%) reported improvement in symptoms. Estimated 3-year overall survival was 94% with radical hysterectomy (95% CI 63-99%), 66% with CRT (95% CI 54-75%), 11% with chemotherapy only (95% CI 5-19%), and 7% with no treatment (95% CI 2-17%) (p<0.001). Conclusion: Multi-modality treatment of cervical cancer is effective in low resource settings through coordinated care and pragmatic approaches. Our data support a role for temporizing chemotherapy if delays to CRT are anticipated. Expanded and timely access to radiation is urgently needed. Citation Format: Victoria Umutoni, Cyprien Shyirambere, Ethan Katznelson, Cam Nguyen, Jean Bosco Bigirimana, Aline Umwizerwa, Alan Paciorek, Lisa Bazzett-Matabele, Diomede Ntasumbumuyange, Scott Triedman, Lawrence Shulman, Tharcisse Mpunga, Rebecca DeBoer. Clinical Outcomes and Quality Metrics of Cervical Cancer Treatment in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 46.