title: Analysis of factors contributing to the low survival of cervical cancer patients undergoing radiotherapy in Kenya.
abstract: BACKGROUND
  In contrast to the developed nations, invasive cervical cancer (ICC) is the most common womens malignancy in Kenya and many other locations in sub-Saharan Africa. However, studies on survival from this disease in this area of the world are severely restricted by lack of patient follow-up. We now report a prospective cohort study of ICC in Kenyan women analysing factors affecting tumour response and overall survival in patients undergoing radiotherapy.
  
  
  RESULTS
  Between 2008 and 2010, 355 patients with histologically confirmed ICC were recruited at the Departments of Gynaecology and Radiotherapy at Kenyatta National Hospital (KNH). Structured questionnaires were completed recording socio-demographics, tumour response and overall survival following treatment with combinations of external beam radiation (EBRT), brachytherapy and adjuvant chemotherapy. Of the 355 patients, 42% (146) were lost to follow-up while 18% (64) died during the two year period. 80.5% of patients presented with advanced stage IIB disease or above, with only 6.7% of patients receiving optimal combined EBRT, brachytherapy and adjuvant chemotherapy. Kaplan Meier survival curves projected two year survival at <20%.
  
  
  CONCLUSIONS
  Cervical cancer is preventable yet poverty, poor education, lack of cancer awareness coupled with an absence of regular screening programs, late patient presentation, sub-optimal diagnosis and treatments are major factors contributing to the alarmingly low survival rate of cervical cancer patients in Kenya. It is concluded that simple cost-effective changes in clinical practice could be introduced which would have a marked impact on patient survival in this setting.
authors.affiliation: University of Manchester, Viral Oncology, Research Floor, St Mary's Hospital, Manchester, United Kingdom ; Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: Innocent O
authors.initials: IO
authors.lastname: Maranga
authors.forename: Lynne
authors.initials: L
authors.lastname: Hampson
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Oliver
authors.forename: Anas
authors.initials: A
authors.lastname: Gamal
authors.forename: Peter
authors.initials: P
authors.lastname: Gichangi
authors.forename: Anselmy
authors.initials: A
authors.lastname: Opiyo
authors.forename: Catharine M
authors.initials: CM
authors.lastname: Holland
authors.forename: Ian N
authors.initials: IN
authors.lastname: Hampson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D007630:Kenya; D059012:Lost to Follow-Up; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult