Alcohol Abuse Decreases Pelvic Control and Survival in Cervical Cancer

Abstract

Purpose We examined the incidence and effect of alcohol abuse on pelvic control (PC), disease free survival (DFS) and overall survival (OS) in locally advanced cervical cancer patients undergoing definitive radiation (RT). Methods Between 2007– 2013, 95 patients treated with RT were reviewed, and the tumor characteristics, RT dose, treatment time, chemotherapy, and number of cycles recorded. The association between alcohol abuse and DFS, OS, and duration of PC was analyzed using multivariable Cox proportional hazards models. Results Of the 95 patients with an average age of 54.8 years (range, 27–91 years), 30% were FIGO stage 1B1, 1B2, 2A; 52% stage 2B, 3A; and 18% stage 3B, 86% of the patients were treated with weekly cisplatin chemotherapy. Alcohol history showed that 10 (10.5%) patients met the CDC criteria for heavy alcohol use. With a mean follow up time of 2 years, 85 patients (88.5%) achieved PC and 86 patients (90.5%) were free of distant metastasis. 82 patients (86.3%) were alive at point of last follow up. When controlling for total treatment time, excessive alcohol abuse was significantly associated with a decrease in DFS (p=0.005, HR of 6.19, 95% CI (1.73,22.18)), and OS (p=0.001, HR 6.68, 95% CI (2.10,21.26)) and PC (p=0.029, HR 3.10, 95% CI (1.13,8.56)) on univariable analysis. On multivariable analysis, excessive alcohol abuse was significantly associated with a decrease in DFS (p=0.005, HR 10.57, 95% CI (2.07, 53.93)) and OS (p=0.001, HR 10.80, 95% CI (2.57, 45.40)). Conclusion In this small hypothesis generating series of patients with heavy alcohol use, the data would support the association that heavy alcohol use increases the risk of cancer recurrence and mortality. Additional research is required to define better the patient and treatment related factors which may be targeted for intervention.

Pap smear outcomes in elderly women living with HIV and HIV-negative matched controls

“…33 The only demographic factors that remained significant when comparing WLHIV with normal versus abnormal Pap results included alcohol use and number of serially negative Pap smears. Consistent with the findings of others, alcohol use has recently been associated with development of CIN1, 34 progression to cervical cancer, 35 and reduced pelvic control in women undergoing radiation for cervical cancer, 36 possibly due to changes in immune function and other carcinogenic metabolic effects. Per ACOG guidelines, total hysterectomy is an indication to discontinue Pap smears except in those with a history CIN2 or a more severe lesion within the preceding 20 years 37 In our patients, higher rates of hysterectomy in the HIV-positive group were not protective against subsequent abnormal cytology.…”

Global distribution, risk factors, and recent trends for cervical cancer: A worldwide country-level analysis

“…These associations could be explained by the carcinogenic effect of alcohol and the behavior of drinkers after alcohol intake. Studies have shown that heavy alcohol use was a risk factor for cervical cancer [27][28][29]. The primary metabolite of ethanol, acetaldehyde, and oxidative stress associated with alcohol could result in DNA methylation which could, in turn, increase the risk of cervical cancer [30].…”

Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

“…In California, our study showed a decrease in cervical cancer outcomes for black patients and those from low SES neighborhoods. Cervical cancer treatment, in general, is often plagued by confounders of being in a low SES, such health related challenges like tobacco and substance abuse, poor nutrition, poor social support and access, which adversely affects long term outcomes [18,19]. Furthermore, patients with a poor SES often lack medical coverage, have barriers and unequal access to improvements in cancer treatment that may contribute to observed differences in survival.…”