Cervical cancer practice patterns and appropriateness of therapy

OBJECTIVE: This study was undertaken (1) to describe practice patterns for treatment of cervical cancer on a national scale, including patient charact eristics associated with receiving appropriate versus inappropriate therapy , and (2) to determine whether mortality rate differences exist between pat ients who were treated appropriately and those who were treated inappropria tely. STUDY DESIGN: We defined treatment appropriateness in cases of cervical can cer according to general recommendations for therapy for each International Federation of Gynecology and Obstetrics stage. In an analysis of data obta ined from the Surveillance, Epidemiology, and End Results Program for 1988 through 1994 we determined the associations of patient demographic characte ristics and tumor characteristics with treatment appropriateness. The assoc iation between treatment appropriateness and overall mortality for as long as 7 years of follow-up was adjusted for age; marital status; Surveillance, Epidemiology, and End Results Program location; International Federation o f Gynecology and Obstetrics stage of disease; lymph node status; tumor grad e; and histologic classification. RESULTS: Overall 90% of all patients were found to have received appropriat e therapy. Important variables significantly associated with being treated inappropriately versus appropriately included age <40 years, positive nodal status, and International Federation of Gynecology and Obstetrics stage IV disease. Important variables significantly associated with receiving no th erapy versus receiving appropriate therapy were age greater than or equal t o 60 years, International Federation of Gynecology and Obstetrics stage IV disease, positive nodal status, and unknown nodal status. in a comprehensiv e model that included demographic factors and tumor characteristics, the ad justed hazard ratio for mortality among patients who were treated inappropr iately versus appropriately was 0.87 (95% confidence interval, 0.70-1.09). The adjusted hazard ratio for mortality among patients who did not receive therapy versus those who were treated appropriately was 2.92 (95% confidenc e interval, 2.44-3.48). CONCLUSIONS: In an analysis of data from a tumor registry, cervical cancer practice patterns were generally found to follow accepted treatment guideli nes. Appropriateness of therapy did not vary widely according to demographi c variables. Although patients who received no therapy had an elevated risk of death with respect to that of patients who were treated appropriately, patients who were treated inappropriately had a mortality rate similar to t hat among those who were treated appropriately (perhaps because of limitati ons in Surveillance, Epidemiology, and End Results Program data). Results o f this preliminary study suggest a need for further research on effectivene ss of cervical cancer therapies in the general population.