Patterns of care for women with cervical cancer in the United States.

National Cancer Institute, Surgery Section, Bethesda, Maryland 20892-7436, USA.
Cancer (Impact Factor: 4.9). 08/2008; 113(4):743-9. DOI: 10.1002/cncr.23682
Source: PubMed

ABSTRACT Recommendations for pretreatment evaluation and treatment of cervical cancer have significantly evolved over the last decade because of the results of multiple randomized studies comparing the addition of platin-based chemoradiation as well as the widespread dissemination and use of imaging modalities. This analysis was initiated to determine any systemic changes in management of cervical cancers.
Surveillance, Epidemiology, and End Results program data were used to sample newly diagnosed women in 1997, 2000, and 2001 with cancer of the cervix. A total of 3116 women with no previous diagnosis of cancer were selected. Data were reabstracted, additional information not routinely collected was obtained, therapy was verified with the treating physician, and multiple endpoints were analyzed.
A marked rise was observed in the percentage receiving chemotherapy (34% to 85%) as well as concurrent chemoradiation (20% to 72%) from 1997 to 2001.
The significant change in the management and treatment of cervical cancer appears to correspond temporally with the publication of 5 clinical trials, all of which showed a significant improvement in overall survival associated with chemoradiation. This change also corresponded with the NCI Clinical Announcement that was disseminated in 1999 to those oncologists most likely to treat women with cervical cancer.

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    ABSTRACT: Objectives 1) To understand whether women who are older when diagnosed with cervical cancer have a poorer survival compared to those younger, and if so, to determine the relative importance of patient, tumor and treatment factors. 2) To review whether older women are candidates for aggressive curative treatment for their cervical cancer and the age related effectiveness and toxicity. Methods A review of the published English literature from 1990-2014 using search terms related to cervical cancer and older age was conducted. Results A number of confounders may influence whether advanced age impacts survival such as patient comorbidities, stage, histology, grade, no or incomplete treatment, less radical surgery, palliative rather than curative treatment, lack of adjuvant radiation after surgery, lower rates of chemotherapy and others. When older women are treated as aggressively as their younger counterparts, survival is the same; however, especially where radiation or chemotherapy are used, toxicities may occur at the same or slightly higher rate. Conclusions The more recent population based studies have larger sample sizes and minimize the biases seen in single centre studies. They have also corrected for confounders giving a more accurate answer concerning the outcomes of older women treated for cervical cancer. Performance status (or “frailty”) and not chronologic age should define the optimal treatment strategy for older women with cervical cancer. Treatment related toxicities can be managed with treatment breaks or dose reductions. For those who receive curative treatment, the outcomes appear similar regardless of age.
    Maturitas 07/2014; · 2.84 Impact Factor
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    ABSTRACT: To estimate the feasibility and conversion rate of laparoscopic radical hysterectomy (LRH) in early-stage cervical cancer. Data were collected from the medical records of 260 consecutive patients with stage IA2 to IIA2 cervical cancer who had undergone LRH, regardless of age, body mass index, prior abdominal surgery, uterus size, or tumor size. The median patient age was 48 years (range, 26-78 years), 11.9 % of whom were elderly (≥65 years), 11.2 % were obese (≥30 kg/m(2)), 15.4 % had undergone previous abdominal surgery, and 13.1 % had a tumor larger than 4 cm. Negative-margin resection was feasible in all patients except one. The median operative time and estimated blood loss were 253 min (range, 111-438 min) and 300 mL (range, 80-2000 mL), respectively. Intraoperative and postoperative complications occurred in seven (2.7 %) and 10 patients (3.8 %), respectively. Four patients (1.5 %) required intraoperative conversion to laparotomy, three of which were due to conglomerated metastatic lymph nodes surrounding the aorta (n = 2), the left external iliac vein (n = 1) or the left ureter (n = 1). LRH was still completed in the four conversion patients, and a laparotomy was required for the removal of the conglomerated metastatic lymph nodes and the repair of the injured vessels. The conversion rate to laparotomy among patients undergoing LRH for early-stage cervical cancer was 1.5 % when performed exclusively in consecutive patients. LRH showed comparable feasibility and effectiveness to open radical hysterectomy in the treatment of early-stage cervical cancer.
    Annals of Surgical Oncology 04/2014; · 3.94 Impact Factor

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