Elisabeth J Diver1, Emily M Hinchcliff2, Allison A Gockley3, Alexander Melamed4, Leah Contrino5, Sarah Feldman6, Whitfield B Growdon7. 1. Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA. Electronic address: Elisabeth.diver@stanford.edu. 2. Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: emhinchcliff@mdanderson.org. 3. Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: agockley@partners.org. 4. Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: amelamed@partners.org. 5. Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: lcontrino1@partners.org. 6. Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: sfeldman@partners.org. 7. Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA. Electronic address: wgrowdon@mgh.harvard.edu.
Abstract
OBJECTIVE: This study aims to understand the treatment patterns and clinical outcomes of older women with cervical cancer compared to younger women. METHODS: Women undergoing care for cervical cancer between 2000 and 2013 at two academic institutions were identified. The cohort of older patients was defined as >65 years old at diagnosis. Patient charts were retrospectively reviewed, and clinical variables were extracted. Fisher's exact tests, logistic regression, and Kaplan-Meier analyses were performed. RESULTS: From 2000 to 2013 1119 women with cervical cancer were identified. Of these, 191 (17.0%) were >65 years old at the time of diagnosis. Older women were more likely to present with higher stage disease (p < 0.001). Controlling for stage, older women were less likely to undergo surgery during their treatment course (38% versus 70%, p < 0.001) and more likely to undergo radiation (77% versus 52%, p < 0.001), but no more likely to receive chemotherapy (p = 0.34). If they did undergo surgery, older women were less likely to have a pelvic lymph node dissection performed (41% versus 61%, p = 0.04), though the rate of positive pelvic lymph nodes was not different (p = 0.80). Overall survival was decreased in the older cohort (p < 0.001). A multivariate model identified age > 65 (HR 1.76, 95%CI 1.30-2.40), stage (HR 2.77, 95%CI 2.40-3.21), and ever undergoing surgery (HR 0.60, 95%CI 0.44-0.82) as independently associated with overall survival. CONCLUSIONS: Women over age 65 with cervical cancer are less likely to undergo surgical management and were observed to have a decreased overall survival, even when controlling for use of surgery and stage of disease.
OBJECTIVE: This study aims to understand the treatment patterns and clinical outcomes of older women with cervical cancer compared to younger women. METHODS:Women undergoing care for cervical cancer between 2000 and 2013 at two academic institutions were identified. The cohort of older patients was defined as >65 years old at diagnosis. Patient charts were retrospectively reviewed, and clinical variables were extracted. Fisher's exact tests, logistic regression, and Kaplan-Meier analyses were performed. RESULTS: From 2000 to 2013 1119 women with cervical cancer were identified. Of these, 191 (17.0%) were >65 years old at the time of diagnosis. Older women were more likely to present with higher stage disease (p < 0.001). Controlling for stage, older women were less likely to undergo surgery during their treatment course (38% versus 70%, p < 0.001) and more likely to undergo radiation (77% versus 52%, p < 0.001), but no more likely to receive chemotherapy (p = 0.34). If they did undergo surgery, older women were less likely to have a pelvic lymph node dissection performed (41% versus 61%, p = 0.04), though the rate of positive pelvic lymph nodes was not different (p = 0.80). Overall survival was decreased in the older cohort (p < 0.001). A multivariate model identified age > 65 (HR 1.76, 95%CI 1.30-2.40), stage (HR 2.77, 95%CI 2.40-3.21), and ever undergoing surgery (HR 0.60, 95%CI 0.44-0.82) as independently associated with overall survival. CONCLUSIONS:Women over age 65 with cervical cancer are less likely to undergo surgical management and were observed to have a decreased overall survival, even when controlling for use of surgery and stage of disease.
Authors: Sarah Feldman; Erin Cook; Michelle Davis; Susan T Gershman; Amresh Hanchate; Jennifer S Haas; Rebecca B Perkins Journal: J Low Genit Tract Dis Date: 2018-10 Impact factor: 1.925
Authors: Moses New-Aaron; Jane L Meza; Martha H Goedert; Stephen M Kibusi; Mkhoi L Mkhoi; Caroline Damian Mayengo; James Charles; Siraji Shabani; Kelsie M Musil; Anlan Cheney; Samwel Sumba Journal: Asian Pac J Cancer Prev Date: 2020-07-01