Katharine A Rendle

Longitudinal study on quality of life following cervical cancer treatment in Botswana

Purpose This study longitudinally assessed the quality of life (QoL) in patients who completed chemoradiation (CRT) for cervical cancer in Botswana and compared the QoL for those living with and without HIV infection. Methods Patients with cervical cancer recommended for curative CRT were enrolled from August 2016 to February 2020. The European Organisation for Research and Treatment of Cancer Core Quality-of-Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires, translated into Setswana, were used to assess the QoL of patients prior to treatment (baseline), at the end of treatment (EOT) and in 3 month intervals post-treatment for 2 years, and statistical analyses were performed. Results A total of 294 women (median age: 46 years) were enrolled and followed up for an average of 16.4 months. Of women with recorded staging, most had FIGO stage III/IV disease (64.4%). Women living with HIV (WLWH; 74.1%) presented at earlier ages than those without HIV (44.8 years vs 54.7 years, p<0.001). The QoL for all domains did not differ by HIV status at baseline, EOT or 24 month follow-up. Per QLQ-C30, the mean global health status score (72.21 vs 78.37; p<0.01) and the symptom (12.70 vs 7.63; p=0.04) and functional scales (88.34 vs 91.85; p<0.01) improved significantly from the EOT to the 24 month follow-up for all patients; however, using the QLQ-Cx24 survey, no significant differences in the symptom burden (12.53 vs 13.67; p=0.6) or functional status (91.23 vs 89.90; p=0.53) were found between these two time points. Conclusion The QoL increased significantly for all patients undergoing CRT, underscoring the value of pursuing curative CRT, regardless of the HIV status.

Patient Perspectives on Primary HPV Testing for Routine Cervical Cancer Screening

Effects of Message Framing on Cervical Cancer Screening Knowledge and Intentions Related to Primary HPV Testing

Abstract Numerous national guidelines now include primary human papillomavirus (HPV) testing as a recommended screening option for cervical cancer in the United States yet little is known regarding screening intentions for this specific screening strategy or interventions that may increase uptake. Gain- and loss-framed messaging can positively impact health behaviors; however, there is mixed evidence on which is more effective for cervical cancer screening, with no published evidence examining HPV testing. To help address this gap, this study compared the effects of message framing on screening knowledge and intentions related to primary HPV testing. We randomized females aged 21–65 (n = 365) to receive brief messaging about cervical cancer screening with either gain- or loss-framing. In January–February 2020, participants completed pretest and posttest measures evaluating cervical cancer knowledge, beliefs, and intentions to be screened using HPV testing. We used generalized estimating equations to model message and framing effects on screening outcomes, controlling for age, education, race, and baseline measures. In comparison to pretest, messaging significantly increased HPV-related screening intentions [adjusted OR (aOR): 2.4 (1–3.5)] and knowledge [aOR: 1.7 (1.2–2.4)], perceived effectiveness of HPV testing [aOR: 4.3 (2.8–6.5)], and preference for primary HPV screening [aOR: 3.2 (1.2–8.5)], regardless of message framing. For all outcomes, no significant interaction by message framing was observed. Brief public health messaging positively impacted HPV-related screening intentions, knowledge, and beliefs, independent of message framing. In conjunction with other strategies, these results suggest that messaging could be an effective tool to increase uptake of primary HPV testing. Prevention Relevance: Primary HPV tests are more sensitive and offer greater reassurance than Pap tests alone yet use for routine cervical cancer screening remains low. Brief public health messaging can positively impact awareness, knowledge, and screening intention regarding primary HPV testing. Messaging campaigns paired with other strategies can increase uptake across populations. See related Spotlight, p. 823

Impact of the COVID-19 Pandemic on Cervical Cancer Treatment Delays in Botswana

PURPOSE Although the majority of cervical cancer cases are in sub-Saharan Africa, little is known regarding how the COVID-19 pandemic affected cancer care in this context. Drawing from robust longitudinal data, this study aimed to assess cervical cancer treatment patterns in Botswana before and during the pandemic. METHODS Longitudinal clinical and patient-reported data from a cohort of over 1,000 patients seen at a gynecologic oncology multidisciplinary team clinic in Botswana were used to evaluate treatment initiation patterns before (April 2018-December 2019) and during (April 2020-December 2021) the pandemic. The primary outcome was timeliness of treatment, defined as the number of days between the patient's first clinic visit and treatment initiation date, and categorized as timely (≤30 days), delayed (>30 days), or no treatment. The primary exposure was time of visit (pre–COVID-19 v COVID-19), defined by the month of the clinic visit. RESULTS Of the 559 patients with cervical cancer diagnosed during the study period, 336 were seen pre–COVID-19, and 223 were seen during the COVID-19 period. During the pandemic, a higher proportion of patients experienced treatment delays (66.4%) or received no treatment (24.2%), compared with the pre–COVID-19 period (35.7% and 9.8%, respectively; P < .001). Multivariable regression models indicated that patients seen during the pandemic were 10 times more likely to experience treatment delays (adjusted odds ratio [aOR], 10.01 [95% CI, 5.69 to 17.62]) and 14 times more likely to receive no treatment (aOR, 14.16 [95% CI, 7.14 to 28.10]). CONCLUSION The pandemic exacerbated treatment delays for patients with cervical cancer in Botswana. There is a need for evidence-based strategies to address these treatment delays, considering the disproportionate burden of disease and persistent disparities in access to care in Botswana and other low- and middle-income countries.