Impact of age on receipt of curative treatment for cervical cancer: an analysis of patterns of care and survival in a large, national cohort

Abstract

Purpose: Disparities in the receipt of standard of care based on age have been identified for several types of cancer including cervical cancer. The purpose of this study is to analyze patterns of care and survival for older patients receiving definitive treatment in a large, national cohort.

Materials and methods: The National Cancer Database was queried for patients with FIGO/AJCC IB2-IVA cervical cancer diagnosed from 2004 to 2014 who underwent definitive radiation or concurrent chemoradiation. Standard of care was defined as concurrent chemotherapy with external beam radiation and brachytherapy to a total dose ≥70 Gy. Multivariable logistic regression was used to determine factors associated with the receipt of standard of care. Multivariable Cox regression was used to determine covariables associated with differences in overall survival.

Results: 24,126 patients met inclusion criteria including 4052 women 61-70 years old, 2471 women 71-80 years old, and 1325 women over 80 years old. A smaller percentage of patients over age 60 received standard of care compared to younger aged patients. On multivariable analysis, older patients were less likely to be treated with standard of care. On multivariable Cox regression, ages 71-80 (HR 1.25, 95% CI-1.16-1.36, p < .001) and age > 80 (HR 1.90, 95% CI 1.73-2.07, P < .001) were associated with decreased overall survival. On subgroup analysis for patients with significant comorbidities, treatment with standard of care resulted in increased 5-year OS as compared to incomplete treatment.

Conclusions: Age was found to be an independent predictor for the receipt of standard of care treatment for cervical cancer.

Keywords: Cervical cancer; Disparities; Older patients.