Solomon Kibudde

Impact of Waiting Time and Treatment Duration on Short-Term Outcomes for Patients With Locally Advanced Cervical Cancer at the Uganda Cancer Institute: The Challenges in Resource-Limited Settings

PURPOSE Cervical cancer remains a significant public health burden, especially in sub-Saharan Africa. The waiting time and treatment duration are key indicators of quality in oncology care, and guidelines recommend that chemoradiation for patients with locally advanced cervical cancer (LACC) should be completed within 8 weeks. This study aimed to quantify waiting times and treatment durations for LACC at the Uganda Cancer Institute and identify bottlenecks in the radiotherapy treatment pathway. MATERIALS AND METHODS This prospective study involved 196 patients with LACC. The department’s treatment protocol for LACC allows either conventional fractionated radiotherapy (CFRT) at 50 Gy/25# or hypofractionated radiotherapy (HFRT) at 45 Gy/15#, followed by brachytherapy at 24 Gy/3#. Nine key treatment milestones were documented from diagnosis to brachytherapy completion. The impact of social determinants of health on waiting times was analyzed. Responses were assessed 6 months after treatment completion. RESULTS Patients spent a median delay time of 41 days and a median waiting time of 88 days. The median external beam radiation therapy duration was 40 days for CFRT, compared with 24 days for HFRT. The median waiting time before initiating brachytherapy was 40 days, leading to an overall treatment duration of 85 days for CFRT and 66 days for HFRT. Only 18% of patients on CFRT and 37% of patients on HFRT completed within timelines. The proportions of patients with either waiting times or treatment duration of ≤8 weeks who had complete responses were comparatively greater than those who started treatments after >8 weeks. CONCLUSION Only 25% completed treatment within the recommended timelines. The long waiting time for brachytherapy makes it impossible to finish within timelines. Strategies to expedite access to brachytherapy are necessary to enhance radiotherapy quality.

A Retrospective Analysis of the Impact of HIV Infection on Outcomes of Locally Advanced Cervical Cancers Treated With Either Conventional or Hypofractionated Radiotherapy: The Uganda Experience

PURPOSE We annually treat more than 800 new patients with cervical cancer, where the majority (approximately 60%) have locally advanced disease and approximately 40% of them are infected with HIV. To optimally care for this large number of patients in low-income settings is difficult. From July 2011, we started using 45.0 Gy/15# hypofractionated radiotherapy (HFRT) as a substitute to 50.0 Gy/25# conventional fractionated radiotherapy (CFRT), for the treatment of locally advanced cervical cancer (LACC). This study aims at comparing the 5-year treatment outcomes between patients with LACC, known HIV serostatus, and treated with either CFRT or HFRT. METHODS A retrospective study was conducted according to demographic/clinical data, radiotherapy fractionations, and outcomes. Factors considered were FIGO stages IIB-IIIB, known HIV serostatus, and had completed external-beam radiotherapy and intracavitary brachytherapy. The primary end point was overall survival; the secondary end points were toxicity and compliance. RESULTS The study included 221 patients. Squamous cell carcinomas were 95.1% and adenocarcinomas 2.3%. The median age was 45.0 (interquartile range, 38.0-52.0) years. Stages IIB, IIIA, and IIIB were 38.9%, 6.3%, and 54.8%, respectively. HIV-positive and HIV-negative were 87 (39.4%) and 134 (60.6%), respectively. Chemoradiation was administered in 100 (45.2%), and 52 (52.0%) completed chemotherapy. CFRT/HFRT were 116 (52.5%)/105 (47.5%). At 24 months, the overall response was 54.1% for HIV-negative compared with 45.0% for HIV-positive ( P value .262). There was no significant differences in acute/late toxicity grades ≥ 2 for HIV-negative/positive treated with HFRT/CFRT. At 60 months, the survival probabilities were 45.7% and 27.7% for HIV-negative and HIV-positive treated with CFRT ( P value = .006), whereas it was 44.2% and 30.7% for HIV-negative and HIV-positive treated with HFRT ( P value = .048), respectively. CONCLUSION For the treatment of LACC with known HIV serology, there was no significant statistical difference in terms of response, toxicity, and compliance between CFRT and HFRT. However, the difference in overall survival between HIV-negative and HIV-positive was significant.