Patients with locally advanced cervical cancer who receive chemoradiation therapy and brachytherapy and complete treatment within eight weeks have a superior overall survival rate compared to those who don’t receive this treatment, according to a UCSF study. The inclusion of brachytherapy in particular, even if treatment duration extends beyond eight weeks, is associated with an improved overall survival.
The retrospective cohort study included more than 10,000 patients with locally advanced cervical cancer from the National Cancer Database (NCDB). “The results of this robust study show how to achieve the best outcomes for patients with cervical cancer,” said Lee-may Chen, MD, gynecologic cancer surgeon and director of UCSF’s Division of Gynecologic Oncology, who was the senior author on the study.
Fewer than 30% of patients nationwide receive standard of care treatment for cervical cancer
For the study, the UCSF research team defined standard of care treatment as receiving external beam radiation therapy (EBRT) with concurrent chemotherapy and brachytherapy and completing treatment within eight weeks.
The study found that 59.4% of patients received brachytherapy, and only 29.3% of patients completed treatment within eight weeks. Patients who are Black, publicly insured, low income, less educated or residing in rural areas were less likely to receive standard of care treatment.
“Cervical cancer disproportionately affects the underserved and there are many barriers to care,” Chen said. “For patients on public insurance, it can take longer to get an appointment with a specialist. Cervical cancer is a disease of relatively young women, and lack of childcare can also be a barrier to care.”
Chen coauthored a 2019 review article on brachytherapy as a critical component of primary radiation therapy for cervical cancer. “We sounded the alarm that brachytherapy wasn’t being used enough,” Chen said. “Now, this new study provides the outcomes data.”
Strategies for expanding access to care
The study includes recommendations for increasing access to standard of care treatment, including using patient navigators, implementing interdisciplinary coordination of care and improving brachytherapy training.
“If there’s a shortage of brachytherapy providers, more training is needed to support this procedure,” Chen said. “Our radiation oncology team has worked on a training program, including brachytherapy simulation, to improve throughput here at UCSF. Collaboration is so important. Emi Yoshida, one of our UCSF radiation oncologists, is a coauthor on this study.
“From a gynecology standpoint, early referrals are critical,” she added. “Within cancer centers, social workers can help patients recognize the importance of care and assist with transportation and other barriers. Patients have the best outcomes when they get external beam radiation, chemotherapy and brachytherapy within eight weeks. This is the standard of care for managing locally advanced cervical cancer. Even if it takes longer to complete, patients still have better outcomes as long as brachytherapy is included in the treatment.”
Cancer research and treatment take place within the UCSF Helen Diller Family Comprehensive Cancer Center.
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