1174 - Five-Year Longitudinal Study of Quality of Life after Chemoradiotherapy Treatment of Cervical Cancer in Botswana

Purpose/Objective(s): Cervical cancer is the second most common cancer among women in sub-Saharan Africa and the most common cancer among women in Botswana. Research on the impact of cervical cancer treatment on quality of life (QoL) in sub-Saharan Africa is limited, as most studies focus on high-income countries. This study evaluates the longitudinal quality of life of cervical cancer patients living with or without HIV in Botswana five years after chemoradiotherapy.

Materials/Methods: Between August 2016 and February 2020, histologically confirmed cervical cancer patients at the primary referral center in Botswana who had undergone chemoradiotherapy were prospectively enrolled. Demographic and clinical information, including HIV status, was collected at baseline. The European Organization for Research and Treatment of Cancer Core Quality of Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires were administered at baseline, end of treatment, and 3-month intervals for 5 years post-treatment or until death or lost to follow-up. A repeated-measures ANOVA was used to compare mean QoL scores by HIV status, and a mixed-effects model was used to account for within-patient correlations, controlling for age, HIV status, and cancer stage.

Results: The study included 294 cervical cancer patients (median age 46 years), 74.1% of whom were women living with HIV. Mean global health status as measured by the QLQ-C30 increased from 68.1 at baseline to 84.0 at 5 years (p<0.01). QLQ-C30 functional scales improved from 87.3 to 99.81 (p<0.01), and QLQ-C30 symptom scales decreased from 12.43 to 0.37 (p<0.01). Cervical cancer-specific symptom burden declined from 13.64 at baseline to 0.11 at the 5-year follow-up (p<0.01). Overall functional status, as measured by the QLQ-Cx24, improved from 84.10 to 93.38 (p<0.01). Improvements remained significant in linear trend analysis, though milder associations regarding QLQ-Cx24 functional scales were observed among women without HIV. The greatest reductions in menopause and peripheral neuropathy symptoms were observed toward the end of the 5-year follow-up. No noticeable improvement in sexual activity was observed from baseline (86.51) to the 5-year follow-up (85.51). Sexual enjoyment, measured at 62.96 at baseline, declined by the 5-year follow-up to 54.17.

Conclusion: There were statistically significant improvements in global health status, functional scales, and symptom scales between baseline and the 5-year follow-up, with no significant differences related to HIV status at either point, similar to trends seen in developed countries. These findings reinforce the value of longitudinal survivorship care and inform interventions regarding sexual health-related symptoms of chemoradiotherapy, which remain a challenge five years post-treatment.