Document Type

Capstone Experience

Graduation Date

8-2017

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Amr Soliman

Second Committee Member

Jane Meza

Third Committee Member

Diwani Msemo

Fourth Committee Member

Julius Mwaiselage

Abstract

Background: Cervical cancer is of high concern particularly in developing countries as a leading cause of morbidity and mortality with significant burden on the health system. A better prognosis of cervical cancer could be achieved by early detection, diagnosis and treatment. This study aimed to ascertain the extent of delays, initiation and completion of treatment among patients with cervical cancer, during the referral pathway between Muhimbili National Hospital (MNH) and Ocean Road Cancer Institute (ORCI)- the highest points of referral for cancer care and management in Tanzania.

Methods: This retrospective study included the identification of patients diagnosed with cervical cancer at MNH and referred to ORCI between 2013 to 2015 from logbooks. Sociodemographic and clinical variables were then abstracted, and data analyzed by SAS software version 9.4.

Results: Sample size was 1109 with relatively equal contribution from all years. Patients diagnosed as early stage at MNH had significantly longer wait times (mean 54 days) prior treatment than those with late stage (44 days) p=0.003. There is a significant difference in median time from biopsy results to first appointment at ORCI between at least 2 of the histological categories, where the time for all other histology types was significantly higher than that for adenocarcinoma (0.0063). There is a statistically significant association (p=0.04) between stage at diagnosis (stage at MNH) and treatment. There was a significantly higher wait times for treatment amongst patients from the coastal zone than for those from the lake zone (CI: 4.9,39). There was a marginal statistically significant association (P=0.049) between insurance status and zone of residence. Wait period for treatment is significantly associated with patients’ transition from one stage to the other, particularly among those patients who remained late stage had shorter duration of wait than for those who worsened (p= 0.04). Possession of biopsy results prior MNH was significantly associated with where the patient lives (zone) (p< 0.001) and their marital status (p=0.0088). Median time taken from biopsy results to ORCI appointment, and to initial treatment is greater for those who had biopsies taken from the facility before MNH.

Discussion: Previous research is centered on non-compliance to recommendations for follow-up to an abnormal screening. This study has been able to identify women from some locations in the country, and those with confirmation of diagnosis prior MNH referral, as needing special interventions to receive management for cervical cancer. For the latter group of patients, herein we present a compelling case for ineffective communication as a double cause for delays; from the patient or provider in the referral process where future research can focus on elucidating the differences in survival for these patients. As the referral system for cervical cancer patients strengthens, there is greater need for a revamp with consideration of this patient population.

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