Nav: Home

Study finds not all women get appropriate care for cervical cancer

March 02, 2017

ANN ARBOR, Michigan -- Women with locally advanced cervical cancer whose treatment follows national guidelines for care have better survival, regardless of race, ethnicity or stage of cancer.

But fewer than three out of five women received guideline-based care. For black and Hispanic women, it's just over half, a new study finds. And that could help explain why cervical cancer outcomes tend to be worse for these women.

Researchers looked at records from 16,195 patients treated between 2004 and 2012 for locally advanced cervical cancer. Patient information was reported to the National Cancer Database, which represents 96 percent of the cervical cancer cases in the United States.

To determine whether patients received care in line with national guidelines, the team looked at who received radiation therapy. National Comprehensive Cancer Network guidelines recommend radiation along with chemotherapy for locally advanced cervical cancer.

Overall, 57 percent of patients received guideline-based care. But those rates varied based on race, from 58 percent in white women to 53 percent in black women and 51 percent in Hispanic women.

What might be most surprising is that a larger gap in guideline-based care was seen among patients treated at centers that saw a large volume of cervical cancer patients, compared to low-volume hospitals.

"It's a common misconception," says study author Shitanshu Uppal, MBBS, assistant professor of obstetrics and gynecology at Michigan Medicine. Research looking at surgical outcomes suggests high-volume centers help reduce disparities. But treatment recommendations don't necessarily improve with practice.

"It's clear that the more surgeries you do, the better you get. But the 'more is better' mantra may not apply to guideline-concordant care," he says. "These are facilities that know what to do and they're doing it. But they're not doing it consistently across all populations."

Over the time period, guideline-based care increased across all populations, but black and Hispanic patients still were less likely than white patients to receive care consistent with guidelines.

"Overall, it's better for everyone. We're closing the gap, but there's still a gap. Even in 2012, we see a 5 percentage-point gap in guideline-based therapy," Uppal says.

The study, published in Obstetrics & Gynecology, did not address reasons why patients might not have received guideline-based care. Cervical cancer tends to be diagnosed in younger women and more often in women facing socioeconomic issues. These factors could influence a patient's likelihood to finish treatment, Uppal suggests. Some patients may refuse certain treatments.

The researchers plan to interview individual patients to better understand the reasons for this disparity, and why there might be barriers to some patients getting treatment.

Not that care will ever be 100 percent aligned with guidelines - there are too many complicated factors for each individual patient. But Uppal expects rates around 75 percent would be a reasonable goal. That's comparable to other types of cancer.

"Understanding the 'why' behind our findings is important - not just for minority populations but for all. We can do better," Uppal says.
-end-
Additional authors: Christina Chapman, M.D.; Ryan J. Spencer, M.D.; Shruti Jolly, M.D.; Kate Maturen, M.D.; J. Alejandro Rauh-Hain, M.D.; Marcela G. delCarmen, M.D.; Laurel W. Rice, M.D.

Funding: None

Disclosure: None

Reference: Obstetrics & Gynecology, Vol. 129, No. 2, doi: 10.1097/AOG.0000000000001819

Resources: University of Michigan Comprehensive Cancer Center, http://www.mcancer.org Michigan Medicine Cancer AnswerLine, 800-865-1125 Michigan Health Lab, http://www.MichiganHealthLab.org

Michigan Medicine - University of Michigan

Related Cancer Articles:

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
More Cancer News and Cancer Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...