Mortality risk stratification based on comorbidity status among cervical cancer patients in Lagos, Nigeria

Comorbidity amplifies mortality risk by approximately sixfold in cancer patients and affects about 26% of cervical cancer (CC) patients in Nigeria. However, its impact on CC outcomes has yet to be fully explored.

We analysed data from the Lagos University Teaching Hospital and the NSIA-LUTH Cancer Center in Lagos, Nigeria, between January 2015 and December 2021. Based on the hypertension-augmented Charlson comorbidity index (hCCI), the hazard ratios (HRs) associated with CC mortality were estimated using Cox proportional hazards model.

Our results showed a mortality rate of 30.1/100 women-years with a mean age at death of 59.8 years. Women with hCCI 2-6 had a significant increase in mortality risk in unadjusted (HR 1.68 [95% confidence interval {CI} 1.10 to 2.57]) and age-adjusted models (adjusted HR 1.57 [95% CI 1.02 to 2.42]) compared with those with hCCI 0. When CC stage was considered, the mortality risk gradient by hCCI was pronounced for late-metastatic CC with hCCI 2-6 (HR 2.32 [95% CI 1.23 to 4.39], increasing to 4.15 (95% CI 1.69 to 10.18) in the adjusted model compared with hCCI 0.

Cervical cancer mortality risk increases with an increasing comorbidity score. Routine incorporation of comorbidity scoring in the clinical assessment of CC patients as well as the use of multidisciplinary cancer care teams may positively impact their clinical and psychosocial management.