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Daniels J, Asante K, Tackie JNO, Kyei KA. Survival rate of cervical cancer: a five year review at a Major Teaching Hospital in Ghana, West Africa. Ecancermedicalscience 2024; 18:1663. [PMID: 38439806 PMCID: PMC10911670 DOI: 10.3332/ecancer.2024.1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative retrospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients' medical records. Data analysis was done using the Statistical Package for the Social Sciences software version 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year overall survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facilities in Ghana as well as in other underdeveloped countries.
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Affiliation(s)
- Joseph Daniels
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- https://orcid.org/0000-0002-1466-150X
| | - Kwesi Asante
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Judith Naa Odey Tackie
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kofi Adesi Kyei
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Radiography, University of Ghana, Accra, Ghana
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Khalkhali HR, Gharaaghaji R, Valizadeh R, Kousehlou Z, Ayatollahi H. Ten Years’ Survival in Patients with Cervical Cancer and Related Factors in West Azerbaijan Province: Using of Cox Proportion Hazard Model. Asian Pac J Cancer Prev 2019; 20:1345-1351. [PMID: 31127888 PMCID: PMC6857867 DOI: 10.31557/apjcp.2019.20.5.1345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: There are two basic ways to analyze survival data including nonparametric and parametric methods.
Considering that cervical cancer is the fourth most common cancer among women, this study was conducted using a
suitable regression model for survival data for patients with cervical cancer in Urmia. Material and Methods: In this
historical retrospective study, all patients with cervical cancer who referred to Motahhari Hospital of Urmia during 2004
and 2015 were included in the study and consisted of 109 women with cervical cancer. The data were collected using
checklist which filled with records of patients. The data were described with percent, mean and standard deviation.
The survival function was computed with the Kaplan-Meier method. The adjusted Hazard Ratio for variables were
estimated after fitting the Cox proportion hazard model using Forward Stepwise Likelihood Ratio method with PE=0.1,
PR=0.15. Results: Of the 109 patients, the mean (SD) time of diagnosis was 50.1% (11.7) years. The mean (SD) and
median of follow-up time was 38.23 (32.50) and 27.1 months (Mim:2 months and Max:132 months). Ninty-Three of
patients (88.7%) were in urban area. Using Log-Rank test, the mean score of survival in patients with recurrence of 38.8
months was significantly lower than those without recurrence (102.5 months) (P <0.001). The results of the COX model
showed that the adjusted relative risk of mortality with a diagnostic age of 50 years or more compared to those under
50 years of age was 1.978. The risk for marriage under age 20 was 3.189 compared to the marriage age of 20 years or
more. Conclusion: According to results, the low age of marriage increases the occurrence of advanced stages of cancer
in older ages and as a social and cultural factor has a significant effect on the survival of patients with cervical cancer.
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Affiliation(s)
- Hamid Reza Khalkhali
- Patient Safety Research Center, Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasool Gharaaghaji
- Patient Safety Research Center, Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Rohollah Valizadeh
- Student Research Committee, Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Kousehlou
- Maternal and Childhood Obesity Research Center, Shahid Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Haleh Ayatollahi
- Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Van Kriekinge G, Sohn WY, Aljunid SM, Soon R, Yong CM, Chen J, Lee IH. Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia. Asian Pac J Cancer Prev 2018; 19:933-940. [PMID: 29693347 PMCID: PMC6031794 DOI: 10.22034/apjcp.2018.19.4.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening, was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.
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Latiff LA, Ibrahim Z, Pei CP, Rahman SA, Akhtari-Zavare M. Comparative Assessment of a Self-sampling Device and Gynecologist Sampling for Cytology and HPV DNA Detection in a Rural and Low Resource Setting: Malaysian Experience. Asian Pac J Cancer Prev 2016; 16:8495-501. [PMID: 26745108 DOI: 10.7314/apjcp.2015.16.18.8495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study was conducted to assess the agreement and differences between cervical self-sampling with a Kato device (KSSD) and gynecologist sampling for Pap cytology and human papillomavirus DNA (HPV DNA) detection. MATERIALS AND METHODS Women underwent self-sampling followed by gynecologist sampling during screening at two primary health clinics. Pap cytology of cervical specimens was evaluated for specimen adequacy, presence of endocervical cells or transformation zone cells and cytological interpretation for cells abnormalities. Cervical specimens were also extracted and tested for HPV DNA detection. Positive HPV smears underwent gene sequencing and HPV genotyping by referring to the online NCBI gene bank. Results were compared between samplings by Kappa agreement and McNemar test. RESULTS For Pap specimen adequacy, KSSD showed 100% agreement with gynecologist sampling but had only 32.3% agreement for presence of endocervical cells. Both sampling showed 100% agreement with only 1 case detected HSIL favouring CIN2 for cytology result. HPV DNA detection showed 86.2%agreement (K=0.64, 95% CI 0.524-0.756, p=0.001) between samplings. KSSD and gynaecologist sampling identified high risk HPV in 17.3% and 23.9% respectively (p= 0.014). CONCLUSION The self-sampling using Kato device can serve as a tool in Pap cytology and HPV DNA detection in low resource settings in Malaysia. Self-sampling devices such as KSSD can be used as an alternative technique to gynaecologist sampling for cervical cancer screening among rural populations in Malaysia.
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Affiliation(s)
- Latiffah A Latiff
- Cancer Resource and Education Center (CaRE), Universiti Putra Malaysia, Malaysia E-mail :
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Yang L, Huang XH, Sun L. The p16 INK4aAntibody Immobilization Method for Immonosensor Application. Asian Pac J Cancer Prev 2015; 16:5115-8. [DOI: 10.7314/apjcp.2015.16.12.5115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Krishnatreya M, Kataki AC, Sharma JD, Nandy P, Gogoi G. Association of Educational Levels with Survival in Indian Patients with Cancer of the Uterine Cervix. Asian Pac J Cancer Prev 2015; 16:3121-3. [DOI: 10.7314/apjcp.2015.16.8.3121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Muhamad NA, Kamaluddin MA, Adon MY, Noh MA, Bakhtiar MF, Tamim NSI, Mahmud SH, Aris T. Survival Rates of Cervical Cancer Patients in Malaysia. Asian Pac J Cancer Prev 2015; 16:3067-72. [DOI: 10.7314/apjcp.2015.16.7.3067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilic M, Ilic I. Gynaecological cancer mortality in Serbia, 1991-2010: a joinpoint regression analysis. Asian Pac J Cancer Prev 2015; 16:157-62. [PMID: 25640344 DOI: 10.7314/apjcp.2015.16.1.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This descriptive epidemiological study aimed to analyse the mortality trends from gynaecological cancer in Serbia. Average annual percentage of change (AAPC) and the corresponding 95% confidence intervals (CIs) were computed for trend using joinpoint regression analysis. Nearly 25,000 gynaecological cancer deaths occurred in Serbia during the 1991-2010 period, with the average annual age-standardised mortality rate being 17.2 per 100,000 women. Increase of mortality was observed for cancer of the vulva and vagina (AAPC=+1.3%, 95% CI=0.1 to 2.6), ovarian cancer (AAPC=+0.8%, 95% CI=0.4-1.3) and for cervical cancer (AAPC=+0.7%, 95% CI=0.3 to 1.1). Mortality rates for gynaecological cancer overall declined in women aged 30-39 years, but mortality was increased in middle-aged women (for cervical cancer) and in the elderly (for ovarian cancer). Improvements to and implementation of the national cervical cancer screening programme conducted in 2013 and expected to be finalised in the following years throughout Serbia should contribute to improvement.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia E-mail :
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Zamaniah WIW, Mastura MY, Phua CE, Adlinda A, Marniza S, Rozita AM. Definitive concurrent chemoradiotherapy in cervical cancer--a University of Malaya Medical Centre experience. Asian Pac J Cancer Prev 2014; 15:8987-92. [PMID: 25374241 DOI: 10.7314/apjcp.2014.15.20.8987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre. MATERIALS AND METHODS A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin (40 mg/m2) concurrent with daily EBRT to pelvis of 45-50 Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated. RESULTS The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients. CONCLUSIONS The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.
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Affiliation(s)
- W I Wan Zamaniah
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia E-mail :
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Cho E, Kang MH, Choi KS, Suh M, Jun JK, Park EC. Cost-effectiveness of Korea's National Cervical Cancer Screening Program. Asian Pac J Cancer Prev 2014; 14:4329-34. [PMID: 23991998 DOI: 10.7314/apjcp.2013.14.7.4329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer, which is common in developing countries, is also a major health issue in Korea. Our aim was to evaluate the cost-effectiveness of Korea's National Cancer Screening Program (NCSP), implemented in 1999. MATERIALS AND METHODS The target population was Korean women 30 years or over who were invited to take part in the NCSP in 2002-2007. By merging NCSP records with Korean Central Cancer Registry data, patients diagnosed with cervical cancer who had been screened were assigned to a "screened group, " while patients diagnosed elsewhere were assigned to a "non-screened group. " Clinical outcomes were measured in terms of life-years saved (LYS), derived from 5-year mortality rates supplied by the Korean National Health Insurance Corporation and National Statistical Office. Direct and travel costs associated with screening were evaluated from the perspective of the payer, the NCSP. RESULTS A diagnosis via screening was associated with 2.30 LYS, and the incremental cost-effectiveness ratio (ICER) estimate for screening was 7,581,679 KW/LYS (6,727 USD/LYS). ICER estimates were lower for older patients (≥ 50 years) than younger patients (4,047,033 KW/ LYS vs 5,680,793 KW/LYS). The proportion of early-stage cancers detected was 16.3% higher in the screened group. CONCLUSIONS In light of Korea's per capita gross domestic product (32,272 USD in 2012), the current NCSP's incremental cost per LYS appears acceptable.
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Affiliation(s)
- Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea.
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Abstract
Objective The number of elderly patients being diagnosed with cervical cancer is increasing, and the outcome of cervical cancer related to age is controversial. We conducted a retrospective analysis in patients treated for advanced cervical cancer in order to investigate patient characteristics and prognosis of older patients. Methods Medical records were collected of 159 patients with cervical cancer who had been treated with radiotherapy or combined radiotherapy and chemotherapy from January 2007 to January 2009. The patients were divided into two age groups: (1) patients ≥65 years old, and (2) patients <65 years old. There were 52 women in group 1, 107 in group 2. Prognosis, patient characteristics, treatment, and toxicities were evaluated. Results With a median follow-up of 36.5 months, local control for groups 1 and 2 was 88.5% and 79.4%, respectively. Disease-free survival for the two groups was 71.2% and 67.3%; overall survival was 73.1% and 72.9%. As shown by univariate analyses, there was no statistically significant difference between the two groups (P > 0.05). Seventy-six patients had human papillomavirus (HPV) at diagnosis (twelve women ≥65 years, 64 women ≤65 years; P = 0.000). Forty-two women tested positive for HPV 16, while 32 women tested positive for HPV 18 respectively. Pelvic and/or paraaortic lymph-node metastasis was found in 25 patients (eight in group 1, 17 in group 2; P = 0.960) on computed tomography scan. Of the 159 patients analyzed, sixteen patients (16/52) in group 1 received concurrent chemotherapy, while 96 (96/107) in group 2 completed that treatment. Conclusions Cervical cancer has the same prognosis in old and young women. Age may not be an independent increased risk of death in women with cervical cancer, and the age-group is at lower risk for virulent HPV strands (HPV 16/18) compared to younger patients. Treatment recommendations were implemented less often for older patients. Radiotherapy remained the most common treatment chosen for elderly patients. This confirms that there is a stronger need to pay attention to the elderly patient.
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Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, People’s Republicof China.
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