Patient and Disease Related Factors Associated with Lost-to Follow-Up/Drop-Outs of Cervical Cancer Patients: A Study at a Major Cancer Hospital in South India


Objective: Cervical cancer is the one of most common cancer in India, and a significant proportion of patientsdo not complete the prescribed courses of treatment and post therapy surveillance, due to deficiencies in treatmentavailability, accessibility, affordability and other socio-demographic factors. Materials and
Methods: Cervicalcancer patient data for the year 2006-2007 were collected during June-August, 2008 from the Regional CancerCentre (RCC), Thiruvananthapuram, Kerala, India and investigated for socio-economic, demographic anddisease (SEDD) related factors impacting patients to drop-out during treatment and patients to loss to follow-up(LFU) post therapy. Odds ratio (OR) for drop-out and LFU and their 95% confidence intervals (CIs) accordingto SEDD factors were estimated through logistic regression model.
Results: Among a total of 784 patients, 94(12%) did not complete the initially planned treatment and among 690 cases who had completed the initiallyplanned treatment, 34% were lost to follow up (LFU). In the multivariate analysis, higher chances of LFU forolder patients (OR=1.8; 95% CI: 1.1-3.1), widowed/divorced/separated/unmarried (OR=1.5; 95%CI: 1.0-2.1),middle school education (OR=1.8; 95% CI: 1.0-3.1), poorer performance status (OR=2.4; 95% CI: 1.2-5.0) andin higher stages (OR= 4.6; 95% CI: 2.1- 10.3). Higher chances of drop-outs were noted for patients with mediumincome (OR=2.0; 95% CI: 1.0-4.1), higher stages (OR=4.8; 95% CI: 1.9-12.2) and ischemic heart disease (OR=3.4;95% CI: 1.1-10.9).
Conclusion: Drop-out rates are associated with disease related factors and patients in theLFU group were affected mainly by SEDD factors. Physicians should be aware of patients’ different needs inthese two different phases, thus improving the retention rate in the near future of cancer treatment.