Susan Citonge Msandambwe

Stigma and Its Association With Social Support and Quality of Life Among Patients With Cervical Cancer in Zambia

PURPOSE Zambia is among the countries with the highest cervical cancer incidence and mortality rates globally. Stigma can hinder treatment adherence and overall quality of life for patients with cervical cancer. Research on this topic, however, is lacking in Zambia. This study aimed to assess the levels of stigma among patients with cervical cancer in Zambia and examine the association between social support and quality of life. METHODS We enrolled patients newly diagnosed with cervical cancer at the Cancer Diseases Hospital in Lusaka, Zambia, from July to October 2024. In-person or telephone interviewers collected information on demographic, clinical, and socioeconomic status before treatment. Stigma was assessed using a modified Perceived Stigma Scale, quality of life using the PROMIS-57, and social support with the Multidimensional Scale of Perceived Social Support. Associations between stigma, social support, and quality of life were analyzed using multivariable logistic regression, adjusting for age, education, income, and cancer stage, with significance set at P < .05. RESULTS A total of 213 participants were included in the study with a response rate of 96%. Of the total participants, 30.5% were classified as having high stigma. High levels of support from family (odds ratio [OR], 0.44 [95% CI, 0.22 to 0.87]) and friends (OR, 0.43 [95% CI, 0.21 to 0.91]) reduced the odds of stigma. Severe anxiety, depression, fatigue, sleep disturbances, pain, poor physical function, and low social well-being were all strongly associated with higher stigma (all P ≤ .004). CONCLUSION Perceived cervical cancer–related stigma in Zambia is associated with limited social support and poorer quality of life. Programs to strengthen social network support, as well as targeted mental health treatment, are needed to improve the well-being of patients with cervical cancer in Zambia.

A multidisciplinary approach to strengthening patient navigation among gynaecologic malignancy patients at the Cancer Diseases Hospital in Zambia

Zambia has the third highest incidence of cervical cancer in the world. Patients with gynecological malignancy self-navigate by transmitting referral letters from practitioner to practitioner across different health levels and geographic localities. Specialized oncology services for women with gynecological malignancies are shared between two tertiary hospitals in the capital city: the Cancer Diseases Hospital and the Women and Newborn Hospital. In 2020, a two-day gynecological malignancies multidisciplinary tumor board workshop targeted clinical oncologists, surgical oncologists, radiologists, pathologists, medical social workers, and nursing and palliative care practitioners. It aimed at harmonizing the functions, goals, and benefits of a multidisciplinary approach to patient navigation and cancer care. Eleven participants from the six specialties attended the workshop. More than 70 % of the workshop participants have consistently attended the weekly virtual gynecological malignancies multidisciplinary tumor board meetings. Attendance of these meetings has expanded from practitioners within the capital Lusaka to other practitioners from all the nation's ten provinces. A virtual referral platform and patient dashboard were created. These platforms have improved the navigation of patients through the system via enhanced communication among practitioners. Patient navigation through a multidisciplinary approach in a low-middle-income country is feasible. Further quantitative work is required to establish how this intervention has improved patient care and clinical research efforts for women with gynecological malignancies in Zambia. Health service leaders in low-middle-income countries need to re-examine the workforce and financing to determine how navigation support can be implemented across the cancer care continuum.

Demographic and social determinants of human immunodeficiency virus status among women with cervical cancer in a low-resource setting.

Zambia faces one of the world's highest cervical cancer and human immunodeficiency virus (HIV) burdens, yet how demographics and social determinants of health relate to HIV status among women with cervical cancer remains unclear. We conducted a prospective, Institutional Review Board-approved cross-sectional study of women aged ≥18 years with newly diagnosed cervical cancer at the Cancer Diseases Hospital in Lusaka, Zambia, from June 2022 to April 2025. Participants completed a culturally adapted Accountable Health Communities Health-Related Social Needs questionnaire. Demographic and social need variables were compared by HIV status, with associated factors evaluated via univariable and multi-variable logistic regression. Among 290 women, 160 (55.2%) were living with HIV. They were younger (median age 48 vs 53 years, p = .002), more often unmarried (49% vs 31%, p = .002), and more likely to live in urban areas (62% vs 43%, p = .003) than women living without HIV. They reported greater prior cervical cancer screening (48% vs 28%, p < .001) and knowledge (40% vs 25%, p = .008). Social needs were high across both groups: food insecurity (77%), transport barriers (82%), financial hardship (88%), loneliness (65%), and perceived stress (75%), with no HIV-related differences. In multi-variable analysis, younger age (adjusted odds ratio [aOR] 0.76 per 5 years, 95% confidence interval [CI] 0.66 to 0.87), unmarried status (aOR 3.06, 95% CI 1.79 to 5.35), urban residence (aOR 2.00, 95% CI 1.21 to 3.32), and prior knowledge of cervical cancer (aOR 1.86, 95% CI 1.08 to 3.23) were associated with HIV. No social need domain showed an independent association. In Zambian women with cervical cancer, HIV status is linked to demographic factors and cancer awareness, but not social needs, which were uniformly high across patients. This highlights the need to expand education and screening, especially for younger and unmarried women, and integrate socioeconomic support to improve outcomes in Zambia and similar high-burden settings.