December 6, 2025Open Access

Treatment patterns, care delays and outcomes in advanced cervical cancer: study protocol for a mixed retrospective and prospective single-centre cohort in South Africa

OAOkechinyere AchilonuUniversity of the Witwatersrand OAOluwatosin AyeniUniversity of the Witwatersrand MAMariam AdelekeRoyal Statistical Society

Key Points

Advanced cervical cancer treatment patterns were assessed, highlighting significant care delays and disparities in outcomes.
The study gathered demographic and socioeconomic data from women diagnosed with advanced cervical cancer over five years.
Mixed retrospective and prospective cohort study commenced in 2023 at Charlotte Maxeke Johannesburg Academic Hospital in South Africa.
Findings may inform strategies to enhance healthcare access and outcomes in low-income countries affected by cervical cancer.

Abstract

Introduction Cervical cancer (CaCx) is a leading cause of cancer-related deaths among women in South Africa, often presenting at advanced stages and requiring chemoradiotherapy. In South Africa, the burden is disproportionately high among women living with HIV, with limited access to radiotherapy further compounding treatment challenges. Despite this documented disparity, limited data exist on patients in a South African context. This protocol describes the research methodology to assess patterns of care, treatment delays, interruptions and survival outcomes in patients with advanced CaCx, addressing an urgent need for local data in low-income and middle-income countries to provide evidence-based improvements in care. Methods and analysis The Cervical Cancer Cohort at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH-CCC), initiated in 2023, is a mixed retrospective and prospective single-centre study investigating the characteristics, challenges and outcomes of patients with advanced CaCx. It includes women aged ≥18 years with a histopathological diagnosis of stage IB3–IVA CaCx treated at CMJAH Radiation Oncology. The retrospective component covers data from September 2018 to August 2023. Data collection is complete and the team is currently conducting quality control. The prospective component began in October 2023 and aims to enrol participants over 2 years, with follow-up for up to 3 years. The study is ongoing, and an extension for continued enrolment beyond September 2025 is being sought. Participants provide baseline data on demographics, socioeconomic status, cultural influences and healthcare access, with updates every 3 months. When necessary, the next of kin provides follow-up information. The study aims to inform strategies to improve outcomes and reduce the CaCx burden in South Africa. Ethics and dissemination Ethics approval for this study was obtained from the Human Research Ethics Committee (Medical) at the University of the Witwatersrand in Johannesburg, South Africa, with an ethical clearance certificate (MM221001 MED22-09-085). The results will be widely distributed through presentations at national and international conferences and published in peer-reviewed open-access journals, ensuring wide access to the results.

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