Nonadherence to Guidelines, Low-Volume Centers Linked to Lower Cervical Cancer Survival

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Lower cervical cancer–specific survival has been associated with NCCN guideline nonadherence.
Lower cervical cancer–specific survival has been associated with NCCN guideline nonadherence.

Nonadherence to National Comprehensive Cancer Network (NCCN) guideline treatment recommendations was strongly associated with decreased survival from early-stage cervical cancer, according to a study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology.1

This retrospective, population-based cohort study evaluated data from patients with stage IA to IIA cervical cancer from the California Cancer Registry from January 1995 to December 2010. Guideline adherence was defined as the administration of cervical stage–appropriate treatment including surgical procedures, radiation, and chemotherapy stratified by year of diagnosis. Relationships were analyzed using multivariate logistic regression and Cox proportional hazard models.

Among 10,127 patients, NCCN guideline-recommended treatment was provided to 62.9% of patients. Nonadherent care was significantly associated (P <.01) with lowest and low-middle socioeconomic status (odds ratio [OR], 0.75 and 0.80, respectively), older age (OR, 0.99), presence of comorbidities (OR, 0.76), tumor size 2 cm or larger (OR, 0.48), and stage II disease (OR, 0.49).

Of the patients, 82.3% received treatment at low-volume centers, defined as fewer than 20 patients per year, and low-volume centers were significantly associated with nonadherent care (OR, 0.88; 95% CI, 0.79-0.99; P =.04).

Lower cervical cancer–specific survival was significantly associated with guideline nonadherence (hazard ratio [HR], 2.03; 95% CI, 1.70-2.42; P <.0001) and treatment at a low-volume center (HR, 1.28; 95% CI, 1.05-1.63; P =.04). Other factors associated with lower cervical cancer–specific survival included presence of comorbidities, black race, and Medicaid payer status.

According to the authors, the results of this study suggest that “increased efforts to concentrate care for early-stage cervical cancer patients are warranted.”


1. Pfaendler KS, Chang J, Ziogas A, et al. Stage IA-IIA cervical cancer: disparities in adherence to treatment guidelines and survival in California. Presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.

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