Challenges and Opportunities in the Treatment of Invasive Cervical Cancer in Low-Resource Settings: A Survey of the International Gynecologic Cancer Society Fellowship Programs.
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Fallah Parisa N, Medley Natalie, Birara Fanta Malede, Shaki Maryam H, Daley Christopher, Gashawbeza Batu Biruck, Quynh Tran Thi Nhu, Lobi Husnia Hussen, Mburu Anisa, Phan Ngoc, Nassir Faiza A, Worku Dawit, Mulamira Pius, Rangeiro Ricardina, Changule Dercia Idite, Kalima-Munalula Mukatimui, Origa Martin, Alsayed Mohammed Taha Hussein, Estrada Erick E, Nkalubo Kyemwa Julius, Bowe Saida, Musa Mubiru, Mitchell Adrian, Karmacharya Saujanya, Mitchell Paul, Chege Henry, Dereje Bethel, Trimble Edward L, Ralph Susan, Chuang Linus, Ng Joseph, Mukhopadhyay Asima, Steller Michael A, Schmeler Kathleen M, Randall Thomas C
Аннотация
METHODS: From September to December 2020, one fellow from each of the 12 existing IGCS fellowship programs participated in a survey that assessed capacity for cervical cancer management, including access to care, diagnostics and treatment, cancer surveillance, and palliative care. Descriptive statistics were used for analysis.
RESULTS: Patients at IGCS sites experienced significant delays to care, especially for chemotherapy and radiation therapy. Less than half of the sites had a gynecology-trained pathologist, and only 58% of sites had access to a magnetic resonance imaging machine, though with many delays in obtaining imaging reads. For treatment, neoadjuvant chemotherapy is not commonly used. Access to radiation therapy is poor, with 58% of sites reporting wait times of 5-8 weeks or more. The radiation machine downtime ranges from 1 to 3 months per year, creating gaps where no patients can access this treatment. Palliative care is practiced by variable members of the health care team although hospice services are rare.
CONCLUSION: This study demonstrates significant resource constraints experienced by gynecologic oncology providers in various LMICs when managing cervical cancer. This includes delays to diagnosis, poor access to chemoradiation services, and need for palliative care. Despite these limitations, the IGCS Global Gynecologic Oncology Fellowships have built workforce capacity to manage cervical cancer, serving as local champions to address this disease.