Cisplatin for The palliative treatment of cervical cancer at Moi Teaching and Referral Hospital, Eldoret, Kenya: A two-year experience

Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Objective: In Sub Saharan Africa access to radiation therapy for women with advanced cervical cancer is poor due to the scarcity of radiation machines. In Kenya there is one public functional cobalt machine for a population of 40 million. The cost both direct and indirect are mostly too high for women. We adapted the use of Cisplatin 50 mg/m2 with a 3-4 week interval as an alternative. The effect of this treatment for symptom control is evaluated.

Methods: Women with advanced stage cervix cancer who were not able to go for radiotherapy were planned for palliative chemotherapy with cisplatin 50 mg/m2 iv in combination with iv fluids and antiemetics. We continued chemotherapy until symptoms had subsided or to a maximum of 6 cycles. All women that were offered palliative chemotherapy were included for this study. Data were collected systematically at every visit and captured in an electronic database. Results are evaluated using a descriptive analysis.

Results: In 2011 and 2012 88 women were planned for palliative chemotherapy. 61 went on to have at least one course of chemo. The women not getting chemo progressed quickly, were unfit due to kidney failure, sought treatment elsewhere or were lost to follow up. Stage was distributed as follows: FIGO Stage 1 1.1%, 2A 1.1% (both women delayed treatment and came back with advanced stage), 2B 9.1%, 3A 24%, 3B 55%, 4A 9.1%. The median number of three courses were given (range 1-6) On presentation 88% of women had bleeding, 69% had discharge and 67% complained of pain. For the women that got at least one course of chemo and who could be evaluated during a follow up visit, bleeding improved for 37/43(86%) women, discharge improved for 28/36(78%) women and pain improved for 24/35(69%) women.

Conclusion: Prior to initiating this program advanced cervical cancer patients who presented to hospital were transfused and sent home to die. We have demonstrated that palliative chemotherapy with Cisplatin is feasible and effective in a low resource setting. Bleeding, discharge and pain all improved for the majority of patients who presented to hospital with advanced cervix cancer.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Research Gate

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