1033 - Longitudinal Patterns of Survivorship Care in Cervical Cancer Patients Living with or without HIV in Botswana, 2015-2023
Presenter(s)
C. Kernell1, S. Amoo-Mitchual2, J. George3, S. Tuli4, P. P. Patel5, B. Monare6, M. Kassick7, R. Ketlametswe6, G. Ramontshonyana8, A. Montgomery2, J. A. O. Díaz9, L. Bazzett Matabele10, P. Vuylsteke8, K. Rendle11, and S. Grover12; 1University of Texas at Southwestern Medical School, Dallas, TX, 2University of Pennsylvania, Philadelphia, PA, 3Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA, 4Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, 5Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, 6Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 7Tufts University School of Medicine, Boston, MA, 8Princess Marina Hospital, Gaborone, Botswana, 9Gaborone Private Hospital, Gaborone, Botswana, 10University of Botswana, Gaborone, Botswana, 11Department of Family Medicine & Community Health & Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, 12Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s):
The number of cancer survivors from low-and-middle income countries (LMICs) is rising, but most research has been conducted in high income countries. While studies have characterized the detection and treatment of cervical cancer in Botswana, follow-up and survivorship care after treatment is a severely understudied area. We assessed short- and long-term survivorship visit adherence and factors associated with adherence in patients treated for cervical cancer in Botswana.Materials/Methods:
Between 2015-2023, females with cervical cancer were prospectively enrolled in an observational cohort study. Short- (first 2 years post-treatment) and long-term (3-5 years post-treatment) visit adherence was defined as completing clinic visits at timepoints recommended according to the Botswana National Cervical Cancer Guidelines: biannual (every six months) visits for short-term and annual visits for long-term. Generalized estimating equations (aOR) were used to evaluate factors associated with short-term and long-term adherence.Results:
This cohort included 1181 females treated with definitive or curative intent surgery- or radiation-based primary treatment, with a median age of 47.7 years (IQR, 41.6-58.2 years) and 68.6% living with HIV. Among the short-term analytic cohort (n=772), 45.2% (n=382), 38.2% (n=323), 36.0% (n=304), 33.7% (n=285) were adherent at 6, 12, 18, and 24 months, respectively. On multivariable analysis (n=772), patients who traveled =100 km to the treatment facility (aOR 0.35, p<0.001), were of advanced stage (III-IV) cervical cancer (aOR 0.69, p=0.007), and had to follow-up during the COVID-19 pandemic (aOR 0.72, p=0.005) were less likely to be adherent; patients were less likely to attend subsequent clinic visits compared to the initial 6 month visit: 12 month (aOR 0.82, p=0.002), 18 month (aOR 0.81, p=0.002), and 24 month (aOR 0.81, p=0.002). Among the long-term analytic cohort (n=362), 36.3% (n=151), 32.2% (n=134), and 27.9% (n=116) were adherent at 3, 4, and 5 years, respectively. On multivariable analysis (n=362), patients who traveled =100 km to the treatment facility (aOR 0.36, p<0.001) were less likely to be adherent; patients were less likely to attend subsequent clinic visits compared to the initial 3 year visit: 5 year (aOR 0.57, p=0.009).Conclusion:
Adherence to recommended follow-up care in cervical cancer survivors in Botswana is suboptimal. Strategies to help survivors, particularly those living farther away from treatment facilities and of advanced stage (III-IV) disease, are needed to reduce cervical cancer mortality and improve adherence, in addition to enhanced focus on providing comprehensive survivorship care beyond visit completion.