Improved survival in cervical cancer patients receiving care at National Cancer Institute–designated cancer centers

• Published in: Cancer 2022-10, Vol.128 (19), p.3479-3486
• Main Authors: McDaniels‐Davidson, Corinne, Feng, Christine H., Martinez, Maria Elena, Canchola, Alison J., Gomez, Scarlett Lin, Nodora, Jesse N., Patel, Sandip P., Mundt, Arno J., Mayadev, Jyoti S.
• Format: Article
• Language: English
• Subjects: brachytherapy; California; Cancer; cancer center; Cervical cancer; Cervix; Hazard assessment; Health hazards; Minority & ethnic groups; Oncology; Patients; Radiation; Regression analysis; Regression models; Survival; treatment outcome; uterine cervical neoplasms
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34404

Background Locally advanced cervical cancer (CC) remains lethal in the United States. We investigate the effect of receiving care at an National Cancer Institute–designated cancer center (NCICC) on survival. Methods Data for women diagnosed with CC from 2004 to 2016 who received radiation treatment were extracted from the California Cancer Registry (n = 4250). Cox proportional hazards regression models assessed whether (1) receiving care at NCICCs was associated with risk of CC‐specific death, (2) this association remained after multivariable adjustment for age, race/ethnicity, and insurance status, and (3) this association was explained by receipt of guideline‐concordant treatment. Results Median age was 50 years (interquartile range [IQR] 41–61 years), with median follow‐up of 2.7 years (IQR 1.3–6.0 years). One‐third of patients were seen at an NCICC, and 29% died of CC. The hazard of CC‐specific death was reduced by 20% for those receiving care at NCICCs compared with patients receiving care elsewhere (HR = .80; 95% CI, 0.70–0.90). Adjustment for guideline‐concordant treatment and other covariates minimally attenuated the association to 0.83 (95% CI, 0.74–0.95), suggesting that the survival advantage associated with care at NCICCs may not be due to receipt of guideline‐concordant treatment. Conclusions This study demonstrates survival benefit for patients receiving care at NCICCs compared with those receiving care elsewhere that is not explained by differences in guideline‐concordant care. Structural, organizational, or provider characteristics and differences in patients receiving care at centers with and without NCI designation could explain observed associations. Further understanding of these factors will promote equality across oncology care facilities and survival equity for patients with CC. This study demonstrates survival benefit for patients receiving care for cervical cancer at National Cancer Institute–designated cancer centers that is not explained by receipt of guideline‐concordant treatment. Further understanding of these factors will promote equality across oncology care facilities resulting in survival equity for patients with cervical cancer.