Quantifying cervical cancer radiotherapy care gap: Baseline assessment prior to implementation of a digital Health App.

Purpose: Sub-Saharan Africa accounts for over one-third of global cervical cancer deaths, despite representing only 14% of the world's female population. Radiotherapy (RT) services are essential in the treatment of cervical cancer, and the Uganda Cancer Institute (UCI) is the only oncology center with RT in a country of 50 million. Prior studies show most of the cervical cancer (CxCa) patients do not complete RT within the recommended timeframe of 6-8 weeks, and some miss their brachytherapy boost. This study analyzes care gaps to establish a baseline before implementing a digital health patient navigation app GLOCASSA. Methodology: We quantified radiotherapy care gaps among 104 cervical cancer patients (FIGO IB-IIIC) treated at the UCI between 2023 and 2024, representing 13% of the annual patient volume ethical approval was obtained. A mixed-methods approach was employed, combining retrospective review of radiotherapy charts with a custom mathematical framework for care gap assessment. Patient timelines were reconstructed from consultation through CT simulation, treatment initiation, completion, and follow-up, across three external beam radiotherapy regimens (45 Gy/15 fractions; 50 Gy/25 fractions; 50.4 Gy/28 fractions). We developed a Radiotherapy Care Gap (RCG) model incorporating professional benchmarks (ASTRO, ACR, ARS) to quantify delays, weighted by their clinical importance. Scores were normalized to reflect adherence (<1 expedited/incomplete; =1 standard; >1 delayed). Geospatial analyses were performed using ArcGIS Pro to measure travel distance from patient residence to UCI. Results: Among 104 cervical cancer patients treated with three EBRT regimens followed by brachytherapy, biologically equivalent doses were comparable across schedules (EQD2 ≈ 85-86 Gy). However, treatment completion within the recommended 6-8 weeks was rare, with on-time completion rates of 11% or lower at 6 weeks and ≤ 17% at 8 weeks. The majority of patients had Radiotherapy Care Gap Scores (RCGS) > 1, indicating significant delays, while only a small fraction achieved timely care (RCGS < 1). Extreme delays were observed, with some patients requiring over 30 weeks to complete therapy. Most patients (58%) were treated with 2D/3D techniques, though delays persisted across all modalities. Geospatial analysis showed a median travel time of 4 h to the radiotherapy center, and more than half of patients (53%) missed the recommended 6-week follow-up visit, highlighting substantial geographic and continuity-of-care barriers. Conclusion: Our findings suggest that patient navigation and follow-up support are major unmet needs. Digital health platforms that provide real-time reminders, enable remote symptom reporting, and facilitate coordination between patients and care teams offer promising solutions. Future directions include the implementation of the GLOCASSA-App as a targeted intervention to mitigate identified care gaps.