Compliance with and acute hematologic toxic effects of chemoradiation in indigent women with cervical cancer

Objectives. The goals of this work were to describe the compliance with and acute hematologic toxic effects of chemoradiation for cervical cancer in i ndigent women and to explore the likelihood that chemoradiation is effectiv e outside research settings. We hypothesized that if compliance and toxicit y are not limiting in this high-risk group of patients, the effectiveness o f chemoradiation for cervical cancer in community settings is likely to mir ror the efficacy demonstrated in clinical trials. Methods. This study is a retrospective review of prospectively maintained d ata on women with newly diagnosed cervical cancer treated with chemoradiati on between August 1998 and August 2000. Cisplatin was given weekly at 40 mg /m(2) to a maximum of six courses. A WBC count < 3000/mm(3) resulted in can celation of cisplatin but not radiation, and patients were transfused for h emoglobin <9 g/dl. Statistical analysis was performed using the t test, <ch i>(2) test, and Fisher's exact test. Results. In all, 19 of 65 patients treated (29.2%) missed at least one chem otherapy cycle, with 10 (15.4%) due to missed appointments, 8 (12.3%) due t o a low WBC count, and 1 due to increased creatinine. Nineteen patients (29 .2%) received RBC transfusion during chemoradiation, and two (3%) had plate lets < 75,000/mm(3). Noncompliant patients had a lower mean total point A d ose (7986 cGy vs 8413 cGy, P = 0.04) and longer overall treatment duration (79 days vs 51 days, P < 0.001). No patient had a fatal hematologic complic ation. Conclusion. Nearly a third of the indigent women treated with chemoradiatio n for cervical cancer do not complete the prescribed treatment, and a simil ar number require blood transfusions. In indigent and minority women, the e ffectiveness of chemoradiation protocols may not mirror the efficacy obtain ed in clinical trials. (C) 2001 Academic Press.