Abstract
BACKGROUND: Cancer survival in sub-Saharan Africa is poorly characterized, and Ethiopia lacks large-scale outcome data. Tikur Anbessa Specialized Hospital (TASH), the country's only comprehensive cancer center, receives the majority of referrals, yet survival outcomes and determinants remain underreported. This study evaluated sociodemographic determinants, clinical characteristics, and survival outcomes of patients with solid tumors treated at TASH. METHODS: We conducted a five-year retrospective cohort study including 1,127 adults diagnosed with histologically confirmed solid tumors at TASH between September 2016 and December 2017. Patients were followed until death or censoring at 60 months. Sociodemographic and clinical data were abstracted from medical records. Survival was estimated using Kaplan-Meier methods and compared by log-rank tests. Multivariable Cox regression identified independent predictors of mortality. RESULTS: The median age at diagnosis was 47 years; 65.9% were female, and 47.4% had no formal education. Cervical (21.5%), breast (17.3%), and colorectal (9.1%) cancers were most frequent. Almost half of patients (49.2%) presented with stage IV disease. Over five years, 832 deaths occurred, yielding a case fatality of 73.8%. The median overall survival was 10 months (95% CI: 8.96-11.04), and the 5-year survival rate was 26.2%. Early-stage disease conferred significantly longer survival (26 vs. 8 months; p < 0.001). Patients receiving multimodal therapy had a median survival of 21 months, compared with 3 months among those without chemotherapy. Hormonal therapy (median 24 months) and paclitaxel-based regimens (20 months) were associated with the longest survival. Independent predictors of higher mortality included advanced stage (AHR 2.02, 95% CI: 1.53-2.68), being single (AHR 1.41, 95% CI: 1.11-1.80), carcinogen exposure (AHR 2.35, 95% CI: 1.57-3.53), complications (AHR 1.23, 95% CI: 1.05-1.45), and receipt of palliative care (AHR 1.82, 95% CI: 1.38-2.39). CONCLUSION: Solid tumor patients at TASH experience alarmingly poor outcomes, primarily due to late-stage presentation and limited treatment access. Strengthening early detection, expanding multimodal therapy, and addressing social determinants are critical for improving survival in Ethiopia.