Effect of changes in treatment practice on survival for cervical cancer: results from a population-based study in Manitoba, CanadaReport as inadecuate

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BMC Cancer

, 15:642

First Online: 22 September 2015Received: 20 May 2014Accepted: 24 August 2015DOI: 10.1186-s12885-015-1624-z

Cite this article as: Kang, YJ., O’Connell, D.L., Lotocki, R. et al. BMC Cancer 2015 15: 642. doi:10.1186-s12885-015-1624-z


BackgroundResults from clinical trials in the 1990s led to changes in the recommended treatment for the standard therapy for stage IIB-IVA cervical cancer from radiotherapy alone to chemo-radiotherapy. We conducted the first population-based study in Canada to investigate temporal treatment patterns for cervical cancer and long-term survival in relation to these changes in the treatment guidelines.

MethodsDetailed information on stage and treatment for 1085 patients diagnosed with cervical cancer in 1984–2008 and identified from the population-based Manitoba Cancer Registry MCR in Canada was obtained from clinical chart review and the MCR. Factors associated with receiving guideline treatment were identified using logistic regression. All cause and cervical cancer specific survival were compared in patients who were and were not treated as recommended in the guidelines, using Cox proportional hazards models.

ResultsThe median follow-up time was 6.4 years range: 0.05–26.5 years. The proportion of women who received guideline treatment was 79 % 95 % confidence interval CI: 76–81 %. However, the likelihood of being treated according to the guidelines over time was modified by age p < 0.0001 and tumour stage at diagnosis p = 0.002. Women who were treated according to the guidelines after the change in recommended clinical practice 1999–2008 had a significantly lower risk of death from all causes and from cervical cancer. This was driven by lower mortality rates in cases with stage IIB-IVA tumours all causes of death: hazard ratio HR = 0.60, 95 % CI: 0.43–0.82, p = 0.002; cervical cancer related death: HR = 0.64, 95 % CI: 0.44–0.93, p = 0.02.

ConclusionsThe management of cervical cancer patients in Manitoba, Canada was in good agreement with treatment guidelines although reasons for departure from the guideline recommendations could not be examined further due to lack of data. Treatment of stage IIB-IVA cervical cancers with recommended concurrent chemo-radiotherapy, which is now standard practice, was associated with substantially increased survival, although the effect of changes in clinical practice including maintenance of haemoglobin levels on improved survival cannot be ruled out as a contributing factor.

AbbreviationsFIGOInternational Federation of Gynecology and Obstetrics

MCRManitoba Cancer Registry

HRHazard ratio

CIConfidence interval

AJCCAmerican Joint Committee on Cancer

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Author: Yoon-Jung Kang - Dianne L. O’Connell - Robert Lotocki - Erich V. Kliewer - David E. Goldsbury - Alain A. Demers - Kare

Source: https://link.springer.com/

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