Abstract
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Purpose: Cervical cancer is the most common malignancy among women in Uganda. Most present with advanced disease, when hysterectomy is not possible and cure is less likely. This study reports the proportion recommended for hysterectomy and associated factors, recommended treatments by stage, and treatment uptake. ; Methods: We conducted a prospective study among patients seeking care for cervical cancer at public referral hospitals in Uganda. In-person surveys were followed by a phone call. Descriptive and multivariate statistical analyses examined associations between predictors and outcomes.; Results: Among 268 participants, 76% were diagnosed at an advanced stage (IIB-IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 kilometers of Kampala (OR 3.10, 95% CI 1.20-8.03) and prior screening (OR 2.89, 95% CI 1.22-6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage (IA-IIA) disease, but was associated with recommended treatment modality (chemo-radiation versus primary chemotherapy) for locally advanced stage (IIB-IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was actually recommended. ; Conclusion: Women presented to public referral centers in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy.