Impact of quality of life and geographic distance on radiation adherence in patients with locally advanced cervical cancer residing in rural areas.
Authors: Abuladze Mariam , Surguladze Tamar , Kekelia Elene , Chogovadze Nino , Esakia Tamar , Abuladze Janina , Katcharava Margarita , Otkhozoria Nana , Tsitsilashvili Sofia , Mariamidze Elene , Tchatchiashvili Bakar , Melkadze Tamar , Chokoshvili Nikoloz , Dizon Don S. 
Published: May 2024

e13512

Background: The efficacy of curative-intent chemoradiation in treating cervical cancer is intricately tied to patient adherence to treatment protocols, often influenced by quality of life. In many areas of the world, treatment centers are often located far from where patients live. We sought to evaluate the impact of distance from the hospital and the quality of life on radiation adherence, especially for patients in the Country of Georgia. Methods: A prospective study conducted at Todua Clinic, Tbilisi, Georgia, from May 2023 - January 2024, involved locally advanced cervical cancer patients undergoing chemoradiation. The study was reviewed by the Todua Clinic Research Ethics Board. The questionnaire was offered at a baseline, at a radiation consult. Quality of life was assessed using the Functional Assessment of Cancer Therapy–Cervical Cancer Version 4. Distance categories (50-100km, 100-200km, 200-300km) were measured, and patient information was extracted from medical records. Radiation nonadherence was defined as missing ≥2 days of external beam radiotherapy. Inclusion criteria comprised stage II and III cervical cancer, prescribed chemoradiation therapy, and rural residency. Multivariable logistic regression was performed to control for confounding variables. Results: Out of the total 50 patients who were asked to participate, 22 declined (reasons for declining: 35% -no mood, 15% - too tired, 45% - not interested, 5% found questions inappropriate to answer) and 28 (56%) participated. 53% of patients were deemed adherent to the prescribed treatment. Statistical analyses unveiled an intriguing trend where mean adherence rates increased with distance from the hospital. However, the Chi-squared test yielded a p-value of 0.065, indicating a marginal significance. The breakdown of mean adherence rates by distance revealed 30.8% for 50-100 km, 66.7% for 100-200 km, and 83.3% for 200-300 km. Educational levels did not significantly impact treatment adherence, despite lower educational attainment in more distant rural areas. The analysis of Quality of Life (Score S) exhibited a negative coefficient (-0.01639), suggesting a subtle decrease in the likelihood of treatment adherence as Quality-of-Life scores increased. Conclusions: This study unveils the interplay between living distance, Quality of Life, and radiation adherence in locally advanced cervical cancer patients in the Country of Georgia. Our findings are interesting because, unlike in other countries where adherence tends to drop as distance increases, we noticed that adherence rates went up when patients lived farther away. One possible reason for this is that some patients move temporarily to cities like Tbilisi just for their radiation treatment. However, we recognize the need for a larger group of people to make our results more reliable and better understand their significance.