Survival status and predictors of mortality among patients with cervical cancer in two oncology units in Northwest Ethiopia: a retrospective follow-up study

Abstract

Cervical cancer is the most frequently diagnosed malignancy and a leading cause of death among women in sub-Saharan Africa, including Ethiopia. Despite its high mortality rate, little is known about survival outcomes and predictors of mortality for patients with cervical cancer in Northwest Ethiopia. A hospital based retrospective follow-up study was conducted among patients with cervical cancer diagnosed and treated from 1 February 2017 to 30 January 2022 at Felege Hiwot Hospital and University of Gondar Hospitals. Data were collected using a data abstraction checklist and telephone interviews. The Kaplan–Meier and the log-rank test were used to estimate and compare survival probabilities. Sensitivity analysis was performed assuming that patients lost to follow-up may have died 6 months after their last visit. The Cox regression model identified predictors of mortality with 95% confidence intervals, considering p < 0.05 as statistically significant. The overall survival rate at 52 months of follow-up was 18.63%. The survival rates at 2, 3, and 4 years were 81.2%, 55.89%, and 37.26%, respectively. In the worst-case analysis, survival at 2, 3, and 4 years declined to 65%, 39%, and 26%, respectively. Significant predictors of mortality included age ≥ 50 years (AHR = 3.4, 95% CI: 1.80–6.48, p < 0.0001), HIV positivity (AHR = 2.9, 95% CI: 1.55–5.61, p = 0.001), Travel distance > 65 km (AHR = 1.9, 95% CI: 1.28–3.08, p = 0.002), no history of surgery (AHR = 2.8, 95% CI: 1.33–5.71, p = 0.006), and advanced stage at diagnosis ; Stage III: (AHR = 3.4, 95% CI: 1.95–5.79, p < 0.001), Stage IV (AHR = 6.7, 95% CI: 3.35–13.58, p < 0.001). However, residence, comorbidity, patient delay, anemia and menopausal status were not significant predictors of mortality (P > 0.05). The overall survival rate for patients with cervical cancer was low in this study. The identified predictors highlight the need to expand cervical cancer screening, diagnostic, and treatment services, especially in regions lacking radiotherapy facilities. Special focus should also be placed on elderly women, and women living with HIV.