SAN DIEGO (FRONTLINE MEDICAL NEWS) Failure to adhere to category 1 National Comprehensive Cancer Network guidelines for the management of locally advanced stage IIB-IVA cervical cancer is rampant – and it’s associated with significantly reduced survival, Dr. Jennifer L. Brown reported at the annual meeting of the Society of Gynecologic Oncology.

“Our study demonstrates opportunities to improve quality of care for women with locally advanced cervical cancer,” said Dr. Brown, a gynecologic oncologist at Fox Chase Cancer Center in Philadelphia.

She and her coinvestigators analyzed the American College of Surgeons/American Cancer Society National Cancer Data Base registry for 2002-2012 and identified 24,952 women treated for stage IIB-IVA cervical cancer. The investigators’ interest was in examining patterns of adherence to category 1 National Comprehensive Cancer Network (NCCN) guidelines in this population, and how adherence rates changed during the decade-long study period.

The key category 1 guidelines recommend concurrent radiation and cisplatin-based chemotherapy followed by brachytherapy for the primary treatment of locally advanced cervical cancer. Moreover, prior to initiating this therapy, pelvic and para-aortic lymph node involvement should be assessed with imaging or surgical staging in order to guide the appropriate radiotherapy dose.

Overall, according to Dr. Brown, only 5,935 women (23.8%) were treated in accordance with the NCCN guidelines recommending concurrent radiation and cisplatin-based chemotherapy followed by brachytherapy. Their median survival was 99.8 months, compared with 52.5 months for patients who didn’t receive category 1 treatment.

Similarly, a mere 23.5% of patients with locally advanced cervical cancer underwent pretreatment lymph node assessment. Those who did had a huge advantage in subsequent median survival: 123.2 months, compared with 48.6 months in those who didn’t undergo pretreatment lymph node staging, she continued.

Also, survival was significantly better among patients whose primary therapy was completed in 8 weeks or less: a median survival of 115.4 versus 82.3 months.

Nonadherence to the category 1 guidelines was disturbingly more common for African Americans, Hispanics, women over age 70, and those who were low income or had a low education level.

Compliance with the NCCN treatment guidelines improved over the study period, from roughly 19% in 2002 to 26% by 2012. However, adherence to the pretreatment lymph node assessment recommendations actually declined over time.

Dr. Brown found marked regional variation in adherence to the NCCN guidelines. It was greatest in the Rocky Mountain region and lowest in Kentucky, Tennessee, Mississippi, and Alabama.

She reported having no relevant financial conflicts.


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