Introduction: Delays in the treatment of cervical cancer may be associated with lower survival rates and a higher risk of disease progression. In low- and middle-income countries, the functioning of health systems may exacerbate this problem.
Objective: To determine whether the initial point of care led to delays in the treatment of patients diagnosed with cervical cancer in Quito between 2012 and 2015, and to assess its impact on survival.
Methods: A retrospective cohort study was conducted to analyse the survival of patients with cervical cancer treated at the SOLCA Quito Hospital. Patients were classified according to their initial point of contact (Group 1: initial care in the public health system with subsequent referral to SOLCA. Group 2: comprehensive care at SOLCA) and in relation to the International Federation of Gynecology and Obstetrics 2009 clinical staging at the time of diagnosis. The time to treatment initiation was compared using the Student’s t-test. Survival analysis was performed using Kaplan-Meier curves, estimating the probability of survival over time for both groups, stratified by clinical stage and performing an overall comparison of groups. In addition, the log-rank test was used to compare both survival curves and determine statistical significance using a significant value of p < 0.05.
Results: A total of 1,363 cases were analysed. Group 1 had a mean waiting time of 162 days, while in group 2 it was 62 days to start treatment (p < 0.01). In terms of survival, group 2 versus 1 had a hazard ratio of 0.85 (95% confidence interval: 0.73–1). In terms of subgroups, the results favoured Group 2 in stages III and IV, the latter with an HR of 0.48 (95% confidence interval: 0.37–0.63) p < 0.01.
Conclusions: Delays in the referral of cervical cancer patients from the public system led to delays in the start of treatment, affecting survival in patients with more advanced stages. Significant disparities in access to care highlight the need for future research aimed at identifying the causes of these delays and proposing possible interventions.
