Predictors of survival among cervical cancer patients in Swaziland (Eswatini): A population-based analysis in a resource-limited setting (2016-2024)

Eswatini (formerly Swaziland) has one of the highest prevalence rates of HIV at 25.4% and only recently implemented an HPV vaccine in 2023. The country also reported the highest incidence and mortality rates of cervical cancer in 2021, estimated at 84.5 and 55.7 per 100,000 female population, respectively. This study serves as the first survival analysis of cervical cancer patients in Eswatini, aimed at examining the impact of clinical and demographic factors on cervical cancer survival outcomes. The Eswatini Cancer Registry was screened for cancer patients from 2016 to 2024, yielding a total of 2,349 cervical cancer patients, of whom 603 deaths were analyzed using the Cox proportional hazards model. The primary analysis assessed the association between cancer stage at diagnosis and survival, adjusting for potential confounders (age, smoking status, HIV status, treatment, and basis of diagnosis). Most patients (44.27%) were aged 50 years or older at diagnosis, whereas 31.42% were between 40 and 49 years and 24.31% were 39 years or younger. A significantly higher proportion of patients did not receive any treatment (59.05%, p < 0.001). Advanced cancer stages (Stages 3 and 4) were associated with significantly reduced survival times, with Stage 4 patients experiencing a median survival of about 10 months compared to about 40 months for Stage 1. Treatments (chemotherapy, radiation, surgery) reduced the hazard of death by 30% (HR: 0.70, 95% CI: 0.59-0.84, p < 0.001). In this first population-based survival analysis of cervical cancer in Eswatini, advanced stage at diagnosis and lack of treatment emerged as the strongest predictors of mortality, consistent with evidence in survival of cancer patients. These findings highlight the urgent need to expand access to screening, ensure early detection, and strengthen treatment capacity.