An Audit of Patients referred after Hysterectomy for Carcinoma Cervix to a Cancer Institute in Northern India

The guidelines for preventing unnecessary hysterectomies released by the Ministry of Health & Family Welfare, Government of India, in April 2023, provide monitoring and evaluation framework for prevalence and causes of unnecessary hysterectomies and indications for referrals to appropriate facility for treatment of cancer. This comes after the operational framework for management of common cancers was released by the Ministry in 2016, where screening, identification of invasive cervical cancer and referral pathways for treatment are described in detail. These documents provide guidance to primary and secondary healthcare centers, both government and private, where most of these cancers can be identified. Uttar Pradesh is the most populous state in India. The burden of disease including that of cancer is high and largely unaccounted, since majority of the population resides in impoverished rural or sub-urban regions. In this study, we provide a descriptive account of the indications and condition of patients referred for treatment of cervical cancer after hysterectomy, at a public tertiary-level cancer center in Uttar Pradesh from a random sample of patients registered between October 2020 and December 2023.

The aim of the study was to audit the records of patients referred after hysterectomy with diagnosis or suspicion of carcinoma cervix, between October 2020 and December 2023. The secondary objective was to collect data on initiating qualitative research on attitude of these women toward surgeries like hysterectomy and factors affecting their decision. In total, 203 patients’ records containing complete data as per inclusion criteria were studied; 49 patient records were identified for audit who had undergone hysterectomy before referral to the hospital.

The guidelines for preventing unnecessary hysterectomies of 2023 can be practice changing for hysterectomy services for cancer if widely implemented along with training in diagnosis, treatment and timely referral for cervical cancer.