Assessing factors associated with survival of cervical cancer patients in Kenya: a case of Nairobi county

Abstract

This study assessed factors associated with survival of cervical cancer patients in Kenya. 540 cases of cervical cancer patients diagnosed between 1st January 2013 to 31 December 2013 from KEMRI, Nairobi Cancer Registry were used and were followed up for 5 years in order to identify those that died at the end of 5 years. At univariable analysis, Kaplan Meier survival estimate and Life table were used. At bivariable level, log-rank was used to identify association between the dependent and the different covariates. Multivariable Cox PH model was fitted to identify factors associated with survival time of cervical cancer patients. In the results, median survival time for cervical cancer patients was found to be 38 months. From Cox regression, it was found that nulliparous cervical cancer patients had better survival than cervical cancer patients with parity between 1 – 2 (HR = 5.90; 95% CI = 4.31 – 7.12), 3 – 4 (HR= 3.05; 95% CI = 2.17 – 5.34), or >4 (HR= 1.01; 95% CI = 0.62 – 2.93). Also, cervical cancer patients with no education had better survival than cervical cancer patients with primary (HR = 1.75; 95% CI = 1.41 – 2.67), and tertiary (HR = 2.01; 95% CI = 1.28 – 3.16) education. The results further indicate that the unemployed/retired/casual cervical cancer patients survive better than professionally (HR = 1.70; 95% CI = 1.11 – 2.60) and self-employed (HR = 1.82; 95% CI = 1.19 – 2.79) cervical cancer patients. Furthermore, cervical cancer patients who were diagnosed with cancer stage II or below survive better than cervical cancer patients who were diagnosed with cancer stage IV (HR= 3.00; 95% CI = 1.51 – 5.99). In addition, cervical cancer patients who are non-smokers survive better than cervical cancer patients who are smokers (HR= 2.99; 95% CI = 1.62 – 5.51). Lastly, cervical cancer patients who received Radiotherapy treatment (HR= 0.08; 95% CI = 0.04 – 0.17), chemotherapy treatment (HR= 0.21; 95% CI = 0.10 – 0.43) and those who received both radiotherapy and chemotherapy treatments (HR= 0.06, 95% CI = 0.03 – 0.13) had a lower risk of dying than those that did not receive any form of treatment. We recommend more targeted interventions that promote sensitization of women regarding the risk factors associated cervical cancer, and boost health seeking (cervical cancer screening) behavior among women is required to overcome the observed disparities in survival with cervical cancer by designing. Further nationally representative study on survival of cervical cancer and its associated risk factors is recommended to boost the level of knowledge of cervical cancer prevention and management.