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Introduction: External beam radiotherapy (EBRT) became unavailable in Uganda from February 2016 to November 2017. Following resource stratification guidelines, an alternative treatment strategy was developed. Methods: Bulky early stage to Stage IIIB patients received at least 3 cycles of neoadjuvant chemotherapy (NAC). Surgery was performed if adequate response was achieved and adjuvant therapy given for high risk factors. Chemotherapy versus supportive care was advised in unresectable disease. NAC protocol completion was defined as receiving at least 3 cycles of NAC followed by either surgery, chemotherapy and/or radiation, or best supportive care. The purpose of this study was to determine the completion rate of NAC and assess the adverse events associated with treatment. Data were collected through retrospective chart review. Results: From February 2016 to November 2018, 53 evaluable patients were identified. 86.8% (46/53) of patients presented in Stage IIB or higher. The completion rate of the NAC protocol was 75.5% (40/53). 94.3% (50/53) received platinum-taxane combination. 7.6% (4/52) grade 3 adverse events occurred related to chemotherapy, all hematologic. 18.8% (10/53) patients underwent surgery with 2 aborted cases due to metastatic or inoperable disease. No adverse events related to surgery were reported. 5 patients underwent adjuvant therapy after surgery due to high risk factors or incomplete pathology findings. 26 patients received adjuvant radiation (3 brachytherapy, 23 EBRT after it became available). Reported side effects related to radiation included vaginal fibrosis and skin reactions. Conclusion: In this limited-resource setting, majority of patients completed a NAC treatment strategy for cervical cancer with acceptable toxicities.

Introduction: In Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital. Methods: We developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 – July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher’s exact test, and independent samples t-test were applied. Results: Data were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition. Conclusion: Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.

Cervical cancer is the leading cause of cancer death among women in Uganda. Given the high prevalence of genital human papillomavirus infection, the current unavailability of radiotherapy, and the absence of a national cervical cancer prevention and control program, these deaths will likely increase. Efforts to organize an effective cervical cancer screening and treatment program will require adequate financial resources, the development of infrastructure, training needed manpower, and surveillance mechanisms of the targeted women. Screening with VIA (visual inspection with acetic acid) and HPV DNA testing on self-collected samples with processing at a specific site could, for the first time, make national, large-scale population-based screening feasible in Uganda. Combining screening efforts with timely treatment of all screen positives for HPV infection can prevent progression to invasive cervical cancer. To date, this is the most effective intervention in closing the current prevention gap. Training of health professionals, ongoing construction of new radiotherapy bunkers, and opening of regional centers are all geared towards improving cervical cancer care in Uganda. The Uganda Cancer Institute Bill establishes the Institute as a semi-autonomous agency mandated to undertake and coordinate the prevention and treatment of cancer. Its implementation will be a milestone in cervical cancer prevention and control. However, execution will require political will and an increase in domestic and international investment.