Challenges and Opportunities in the Treatment of Invasive Cervical Cancer in Low-resource Settings: A Survey of the International Gynecologic Cancer Society Fellowship Programs

A large proportion of cancer-related mortality can be attributed to cervical cancer, and 90% of global cancer mortality occurs in low and middle-income countries (LMICs). Efforts to completely eradicate cervical cancer have focused on the prevention of human papillomavirus (HPV) and treatment of precancerous lesions; little emphasis has been placed on managing invasive cervical cancer. In LMICs, cervical cancer care looks different than in higher-income countries and can include increasing educational capacity as well as providing resources for care. The International Gynecologic Cancer Society (IGCS) has focused on creating fellowship training programs to support a new generation of clinicians who are better equipped to diagnose and treat cervical cancer. This survey reports the results of a 2020 survey of the IGCS training sites in Bahamas, Jamaica, Fiji, Guatemala, Ethiopia, Kenya, Uganda, Mozambique, Zambia, Nepal, Qatar, and Vietnam that aimed to establish baseline data at each site, including elements of general access to cancer care, within-country availability of diagnostic and treatment methods, capacity for cancer surveillance, and provision of palliative care. Survey responses indicated consistent lack of resources at all sites, which included long wait times for care, lack of access to pathology or imaging, insufficient access to operative rooms and radiation therapy, limited options for palliative care, and inconsistent monitoring of patients. Of the 12 sites, 6 reported wait times of >5 weeks between cervical cancer diagnosis and specialist appointment. Data were not collected regarding time from onset of symptoms to presentation to care or time from presentation to diagnosis, but similarly delayed timeframes are possible. A total of 7 sites reported no pathologist with training in gynecologic pathology within the country. Wait time for pathology results is thus inflated, though most sites are able to obtain results within 3 weeks. Most sites do have access to remote/telehealth pathology specialists, typically through IGCS international mentors. Most of the sites (11 of 12) have access to computed tomography (CT) imaging, but only 7 have access to magnetic resonance imaging (MRI) and only 3 have access to positron emission tomography-CT. Even with access, cost and time present significant challenges in obtaining imaging for patients. All sites have access to surgical care, though some are limited in their capacity. Chemotherapy is available at 11 of 12 sites, and chemoradiation is available at 10. Delays in surgical care were reported due to lack of operating room availability, postponement for emergent cases, limited availability of blood products, lack of anesthesia staff or anesthetic agent, patient delays, surgeon availability, limited ventilators and other equipment, and limited electricity. Radiation services are available within the country for only some sites, and wait times average 5 to 8 weeks for this intervention. Palliative care is typically provided by gynecologic oncologists, either alone or in conjunction with palliative care specialists. Some sites also have medical oncologists, radiation oncologists, general physicians, or nurses who can administer palliative care. In addition, all sites use follow-up monitoring after initial treatment, but only 8 sites could capture patient outcomes including recurrence. Most sites have a follow-up term of 5 years, with 2 sites having a follow-up term of 7 to 10 years. These results indicate that there are still major economic and logistical barriers to the treatment of invasive cervical cancer in LMICs. Though this is true, the IGCS fellowship program is a model for strengthening and increasing services for cervical cancer management through collaboration and education. This survey is a starting point to assess long-term potential improvement in cervical cancer care in these countries. It also provides insight into what needs are most important in different areas, allowing for efforts to address these gaps in care. Next steps include refinement of the survey, including a larger sample size with more fellowship sites both within and outside of IGCS, incorporating prospective studies and qualitative outcomes, and an assessment of patient access to care, delays in care, diagnostic capability, and availability of resources for each site. (Abstracted from JCO Glob Oncol. 2025 Oct:11:e2500015. doi: 10.1200/GO-25-00015)