Geographic and socio-economic determinants of advanced stage presentation for radiotherapy in cervical cancer: Analytical cross sectional study.

Abstract

Objective: To identify independent geographic and socio-economic predictors of advanced FIGO stage at the time of radiotherapy initiation among cervical cancer patients. Study Design: Analytical Cross-sectional study. Period: January 2024 to December 2025. Setting: Department of Oncology, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur. Methods: Ethical approval was obtained from Institutional Review Board. 120 adult females with histologically confirmed carcinoma cervix prescribed definitive or palliative radiotherapy were enrolled using non-probability consecutive sampling. Excluded were patients with recurrent disease following prior curative treatment or incomplete records lacking essential staging. Data collection integrated clinical staging, estimated geographic distances, and socio-economic questionnaires capturing insurance and assets. Statistical analysis utilized Chi-square tests and multivariate logistic regression to calculate Adjusted Odds Ratios with 95% confidence intervals using SPSS version 23.0. Results: Mean participant age was 51.8±10.9 years, with 68.3% residing rurally. Overall, 70.0% presented with advanced-stage disease (FIGO IIB–IVB). Multivariate logistic regression identified travel distance exceeding 50km (AOR=2.76, p=0.004), low socio-economic status (AOR=3.08, p=0.002), and primary-level education or less (AOR=2.19, p=0.030) as significant independent predictors. Rural residence significance attenuated after adjustment for distance. Subgroup analysis showed 88.2% advanced stage in low SES/distant patients versus 38.5% in high SES/nearby patients. Conclusion: Rural residence and low socio-economic status are primary determinants of advanced-stage cervical cancer presentation. Decentralized screening services and financial support mechanisms are urgently required to improve early detection and survival outcomes in this region, mitigating regional health disparities.