Impact of Waiting Time and Treatment Duration on Short-Term Outcomes for Patients With Locally Advanced Cervical Cancer at the Uganda Cancer Institute: The Challenges in Resource-Limited Settings.

Abstract

Purpose: Cervical cancer remains a significant public health burden, especially in sub-Saharan Africa. The waiting time and treatment duration are key indicators of quality in oncology care, and guidelines recommend that chemoradiation for patients with locally advanced cervical cancer (LACC) should be completed within 8 weeks. This study aimed to quantify waiting times and treatment durations for LACC at the Uganda Cancer Institute and identify bottlenecks in the radiotherapy treatment pathway.

Materials and methods: This prospective study involved 196 patients with LACC. The department's treatment protocol for LACC allows either conventional fractionated radiotherapy (CFRT) at 50 Gy/25# or hypofractionated radiotherapy (HFRT) at 45 Gy/15#, followed by brachytherapy at 24 Gy/3#. Nine key treatment milestones were documented from diagnosis to brachytherapy completion. The impact of social determinants of health on waiting times was analyzed. Responses were assessed 6 months after treatment completion.

Results: Patients spent a median delay time of 41 days and a median waiting time of 88 days. The median external beam radiation therapy duration was 40 days for CFRT, compared with 24 days for HFRT. The median waiting time before initiating brachytherapy was 40 days, leading to an overall treatment duration of 85 days for CFRT and 66 days for HFRT. Only 18% of patients on CFRT and 37% of patients on HFRT completed within timelines. The proportions of patients with either waiting times or treatment duration of ≤8 weeks who had complete responses were comparatively greater than those who started treatments after >8 weeks.

Conclusion: Only 25% completed treatment within the recommended timelines. The long waiting time for brachytherapy makes it impossible to finish within timelines. Strategies to expedite access to brachytherapy are necessary to enhance radiotherapy quality.