No improvement in survival of older women with cervical cancer—A nationwide study

<p>Aim: This study aims to report trends in primary treatment and survival in cervical cancer (CC) to identify opportunities to improve clinical practice and disease outcome. Methods: Patients diagnosed with CC between 1989 and 2018 were identified from the Netherlands Cancer Registry (N = 21,644). Trends in primary treatment and 5-year relative survival were analysed with the Cochran-Armitage trend test and multivariable Poisson regression, respectively. Results: In early CC, surgery remains the preferred treatment for ages 15–74. Overall, it was applied more often in younger than in older patients (92% in 15–44; 64% in 65–74). For 75+, surgery use was stable over time (38%–41%, p=0.368), while administration of radiotherapy decreased (57%–29%, p &lt; 0.001). In locally advanced CC, chemoradiation use increased over time (5%–65%, p &lt; 0.001). It was applied least often for 75+, in which radiotherapy remains most common (54% in 2014–2018). In metastatic CC, chemotherapy use increased over time (11%–28%, p &lt; 0.001), but varied across age groups (6%–40% in 2014–2018). In patients treated with primary chemoradiation, regardless of stage, brachytherapy use increased over time (p ≤ 0.001). Full cohort 5-year survival increased from 68% to 74% (relative excess risk 0.55; 95% confidence interval [0.50–0.62]). Increases were most significant in locally advanced CC (38%–60%; 0.55 [0.47–0.65]). Survival remained stable in 75+ (38%–34%; 0.82 [0.66–1.02]). Conclusion: Relative survival for cervical cancer increased over the last three decades. The proportion of older patients receiving preferred treatment lags behind. Consequently, survival did not improve in the oldest patients.</p>

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