Abstract
BACKGROUND: In Botswana, a multidisciplinary team (MDT) clinic was established in 2015 to streamline care for all patients with gynecological malignancies including cervical cancer, Botswana's leading cause of cancer mortality. METHODS: Patients presenting at the MDT clinic in Gaborone, Botswana, were prospectively enrolled. Temporal trends in stage and treatment distributions were assessed using the Cochran-Armitage χ(2) test. Overall survival was estimated using the Kaplan-Meier method. RESULTS: Between 2015 and 2023, 2345 patients were enrolled. Mean age was 52.0 years (SD 13.1 years) and 62.9% (n = 1474) were living with HIV. Annual volume increased 4-fold by 2023. Most patients had cervical cancer (74.3%), followed by vulvar (11.9%), endometrial (8.8%), ovarian (3.6%), and vaginal (1.3%) cancers. Stage distribution was: Stage I 19.2%, Stage II 23.9%, Stage III 31.3%, and Stage IV 9.4%. Trends toward increased diagnosis of Stage I disease (p < .0018) and decreased diagnosis of Stage II disease (p = .002) were observed in cervical cancer patients over the years of MDT consultation. Two-year overall survival for patients with cervical cancer treated between 2015 and 2019 was 67.1% and increased to 75.2% between 2020 and 2024 (p = .002), potentially driven by increased survival of those with Stage II disease (75.7% vs. 84.8%, p = .025). This coincided with an increase in patients with cervical cancer receiving primary surgery (p < .001) and a decrease in those receiving radiotherapy with concurrent chemotherapy (p < .001) and radiotherapy alone (p < .001). DISCUSSION: Gynecological cancer outcomes after MDT clinic establishment significantly improved over time. Although ongoing efforts to optimize care are still needed, the success of the MDT clinic in Botswana can serve as a model for coordinated multidisciplinary care in other low-resource settings.