Improved survival in cervical cancer patients receiving care at NCI-designated cancer centers (457)

Abstract

<b>Objectives:</b> Locally advanced cervical cancer (CC) remains a lethal disease in the United States, with the standard of care being concurrent chemotherapy and radiation (CRT) with brachytherapy. We investigated the effect of receiving care at an NCI-designated comprehensive cancer center on survival. <b>Methods:</b> Specific study variables from the California Cancer Registry (CCR) were extracted for women diagnosed with locally advanced CC from January 1, 2004, through December 31, 2016, and who had received radiation treatment. Kaplan-Meier was used to compare CC-specific survival by care (diagnosis and/or treatment) at an NCI- designated cancer center using a log-rank test. Cox proportional hazards regression models were used to assess whether <i>')</i> care at an NCI-designated cancer center was associated with risk of CC-specific death, <i>2)</i> whether this association remained after adjusting for hypothesized confounders, and <i>3)</i> whether the association could be explained by the receipt of a guideline-concordant standard of care, CRT and brachytherapy, treatment. <b>Results:</b> The median age of the patients (<i>n</i>=4,250) was 50 years (interquartile range [IQR]: 41-61 years), with a median follow-up time of 2.7 years (IQR: 1.3-6.0 years). Of the 4,250 patients in the sample, 33% were cared for at an NCI-designated cancer center, and 29% died of CC. The Kaplan-Meier plot showed a distinct survival advantage for those who received care at an NCI-designated cancer center (p=0.0001). The hazard of death due to CC was reduced by 21% for those cared for at NCI-designated cancer centers (HR: 0.79, 95% CI: 0.70-0.89). Adjusting for guideline-concordant treatment as well as other covariates minimally attenuated the hazard ratio to 0.83 (95% CI: 0.74-0.95), suggesting that the CC-specific survival advantage associated with care at NCI-designated cancer centers may not be due to receipt of guideline-concordant treatment alone. <b>Conclusions:</b> In the era of personalized medicine for locally advanced cervical cancer, we continue to seek out treatment options that will benefit survival. Our study shows a statistically significant cervical cancer survival benefit among patients receiving care at NCI- designated cancer centers versus those who are cared for elsewhere. This difference does not appear to be explained by receipt of guidelineconcordant care alone and may instead be due to structural, organizational, provider, or otherwise unknown patient characteristics within and outside of an NCI designation. Further understanding of these potential factors will promote equality across institutions and oncology care facilities as well as survival equity for cervical cancer patients.