729P - Patterns of survivorship care of cervical cancer patients with or without HIV infection in Botswana 2015-2022

Background

Botswana’s cervical cancer (CaCx) post-treatment guidelines recommend survivorship care every 6 months for the first 2 years and annually for the next 3-5 years following the end of curative or definitive treatment. The aims were to present patterns of survivorship care of CaCx patients in Botswana with or without human immunodeficiency virus (HIV) and evaluate factors associated with retention in survivorship care.

Methods

Between 2015-2022, women in Botswana with CaCx were prospectively enrolled in an observational cohort study and treated with curative or definitive intent RT or surgery-based treatment. Factors associated with retention in survivorship care were analyzed using multivariable logistic regression modeling (aOR). The ordinal chi-square test was used to assess impact of COVID-19 on follow-up rates.

Results

We evaluated 830 patients, of which 668 should have ≥1 office visit for the first 2 years and 442 for the next 3-5 years of survivorship care, respectively. Among the cohort (n=830), the median age was 47.7 years; 67.8% (n=563) were HIV-positive with 95.4% (n=537) on antiretroviral treatment. In accordance with the first 2 years of survivorship care, 16.3% (n=109) completed follow-up every 6 months. On multivariable analysis for the first 2 years, traveling ≥100 km (aOR 0.44, p<0.001) vs. <100 km for treatment and receiving surgery-based treatment (aOR 0.40, p<0.001) vs. RT were associated with decreased adherence. In accordance with the next 3-5 years of survivorship care, 10.9% (n=48) completed follow-up annually. On multivariable analysis for the next 3-5 years, traveling ≥100 km (aOR 0.47, p=0.016) vs. <100 km for treatment was associated with decreased adherence. HIV status was not associated with adherence for either period. Follow-up rates did not significantly decrease after the onset of the COVID-19 pandemic (April 1, 2020) during the first 2 year period (61.4% vs. 38.6%, p=0.079).

Conclusions

Majority of CaCx patients in Botswana are not adhering to the recommended survivorship care plan, with increased distance from treatment facilities serving as a primary barrier. Future interventions should aim to reduce barriers to care and improve adherence.

Clinical trial identification

IRB Protocol: 820659.

Editorial acknowledgement

Legal entity responsible for the study

University of Pennsylvania; Botswana UPENN Partnership.

Funding

National Cancer Institute (NCI).

Disclosure

K. Rendle: Financial Interests, Institutional, Research Grant: NIH/NCI, Pfizer/Lung Cancer Research Foundation, AstraZeneca/NCCN; Financial Interests, Personal, Speaker, Consultant, Advisor, One time scientific advisory fee paid to me: Merck; Financial Interests, Personal, Financially compensated role, Honoraria & travel grant from MJH Life Sciences to present at conference: MJH Life Sciences. S. Grover: Financial Interests, Personal, Speaker, Consultant, Advisor: Lumonus. All other authors have declared no conflicts of interest.