TY - JOUR
T1 - Benchmarking of the Cervical Cancer Care Cascade and Survival Outcomes after Radiation Treatment in a Low-and Middle-Income Country Setting
AU - Grover, Surbhi
AU - Macduffie, Emily
AU - Nsingo, Memory
AU - Lei, Xiudong
AU - Mehta, Priyanka
AU - Davey, Sonya
AU - Urusaro, Sandra
AU - Chiyapo, Sebathu
AU - Vuylsteke, Peter
AU - Monare, Barati
AU - Bazzett-Matabele, Lisa
AU - Ralefala, Tlotlo
AU - Luckett, Rebecca
AU - Ramogola-Masire, Doreen
AU - Smith, Grace L.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023
Y1 - 2023
N2 - PURPOSETimely radiation treatment (RT) is critical in cervical cancer treatment, but patients in low-and middle-income countries (LMICs) in sub-Saharan Africa often face barriers that delay care. Time to care was benchmarked in a multidisciplinary team (MDT) setting in Botswana.METHODSTime intervals between steps in care were recorded for 230 patients reviewed at MDT between January 2016 and July 2018. Associations between RT delay and overall survival (OS) were evaluated using Kaplan-Meier curves and multivariable Cox proportional hazards models.RESULTSFor patients who received RT (n = 187; 81.3%), the median biopsy to pathology reporting interval was 25 (IQR, 19-36) days and was 57 (IQR, 28-68) days for patients who did not (P =.003). Intervals in care did not differ between patients who did and did not receive RT. Among treated patients, the uppermost quartile interval from pathology reporting to RT initiation was ≥111 days and that from RT simulation to initiation was ≥12 days. Among patients receiving a RT dose of ≥65 Gy (n = 100), the delay from RT simulation to initiation of >12 days was associated with worse median OS (2.0 v 4.6 years; P =.048); this association trended toward, although did not meet, statistical significance on multivariable analysis (hazard ratio, 2.35; 95% CI, 0.95 to 5.85; P =.07).CONCLUSIONThe MDT-coordinated care model allows for systematic benchmarking of the patient treatment cascade. Barriers to timely treatment exist for this cohort in Botswana, and RT delay may be associated with OS of patients receiving curative treatment. Interventions to accelerate the timing of the radiation oncology care cascade may improve clinical outcomes in this LMIC setting.
AB - PURPOSETimely radiation treatment (RT) is critical in cervical cancer treatment, but patients in low-and middle-income countries (LMICs) in sub-Saharan Africa often face barriers that delay care. Time to care was benchmarked in a multidisciplinary team (MDT) setting in Botswana.METHODSTime intervals between steps in care were recorded for 230 patients reviewed at MDT between January 2016 and July 2018. Associations between RT delay and overall survival (OS) were evaluated using Kaplan-Meier curves and multivariable Cox proportional hazards models.RESULTSFor patients who received RT (n = 187; 81.3%), the median biopsy to pathology reporting interval was 25 (IQR, 19-36) days and was 57 (IQR, 28-68) days for patients who did not (P =.003). Intervals in care did not differ between patients who did and did not receive RT. Among treated patients, the uppermost quartile interval from pathology reporting to RT initiation was ≥111 days and that from RT simulation to initiation was ≥12 days. Among patients receiving a RT dose of ≥65 Gy (n = 100), the delay from RT simulation to initiation of >12 days was associated with worse median OS (2.0 v 4.6 years; P =.048); this association trended toward, although did not meet, statistical significance on multivariable analysis (hazard ratio, 2.35; 95% CI, 0.95 to 5.85; P =.07).CONCLUSIONThe MDT-coordinated care model allows for systematic benchmarking of the patient treatment cascade. Barriers to timely treatment exist for this cohort in Botswana, and RT delay may be associated with OS of patients receiving curative treatment. Interventions to accelerate the timing of the radiation oncology care cascade may improve clinical outcomes in this LMIC setting.
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U2 - 10.1200/GO.22.00397
DO - 10.1200/GO.22.00397
M3 - Article
C2 - 37738538
AN - SCOPUS:85172108251
SN - 2378-9506
VL - 9
JO - JCO Global Oncology
JF - JCO Global Oncology
M1 - e2200397
ER -