Adherence to Survivorship Care Visits in Patients With Cervical Cancer in Botswana

The number of cancer survivors from low- and middle-income countries is rising, but most research has been conducted in high-income countries. Although studies have characterized the detection and treatment of cervical cancer in Botswana, survivorship care is a severely understudied area. We assessed short- and long-term survivorship visit adherence and factors associated with adherence in patients treated for cervical cancer in Botswana.

Between 2015 and 2022, females with cervical cancer were prospectively enrolled in an observational cohort study. Based on recommendations in the Botswana National Cervical Cancer Guidelines, adherence was defined as completion of a clinical visit biannually (every 6 months) during short-term survivorship care (0-2 years after treatment) and annually for long-term survivorship care (3-5 years after treatment). Generalized estimating equations (adjusted odds ratio [aOR]) were used to evaluate factors associated with short- and long-term adherence.

This cohort included 857 females treated with definitive- or curative-intent surgery- or radiation-based treatment, with a median age of 47.7 years (IQR, 41.6-58.2 years) and 68.6% living with HIV. On multivariable analysis of short-term care (n = 772), patients who traveled ≥100 km to the treatment facility (aOR, 0.35; P < .001), had advanced-stage (III and IV) cervical cancer (aOR, 0.69; P = .007), and were undergoing care during the COVID-19 pandemic (aOR, 0.72; P = .005) were less likely to be adherent. Results were similar for long-term care.

Adherence to recommended survivorship visits in Botswana is suboptimal. Strategies to help survivors, particularly those living farther away from treatment facilities and with advanced disease, are needed to improve adherence and reduce cervical cancer mortality.