Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Abstract

Although a quarter of cervical cancers occur after the age of 65 years, there is no treatment consensus for these patients. The aim of this work was to survey how physicians treat patients with advanced cervical cancer, focusing on treatment adjustments according to age and frailty status. Specialists were invited to an online survey. Data collected included information on respondent and treatment strategy in four cases (FIGO IIb, FIGO IVa, FIGO IVb, metastatic recurrence) with three age scenarios (45-year-old, 75-year-old and fit, 75-year-old and unfit). We received 237 responses of which 117 were fully completed. Thirty-four percent of respondents reported they had available access to a geriatric team and 25% used a frailty screening tool in routine. Therapeutic strategies did not differ between young and old fit patients. However, treatment modalities and intensity were different for old and unfit patients. Physicians answered that they would treat old fit patients as their younger counterparts but would reduce treatment intensity for old unfit patients. However, even if they were willing to adapt their treatment strategy based on frailty status, most of them do not use the tools that would allow distinguishing “fit” and “unfit” older patients, leaving room for improving accurate geriatric evaluation.

Epidemiology of cervical cancer in elderly women: Analysis of incidence, treatment, and survival using German registry data

“…19 Furthermore, most physicians treating advanced CC do not decide objectively about treatment in elderly patients. 40 Without using frailty screening tools, physicians report adherence to standard care in "fit" elderly patients but administer less intensive treatments to women deemed as "unfit" patients. Further factors, which might contribute to these differences in disease management, might be the presence and severity of comorbidities or older patients refusing aggressive treatments.…”

Impact of chemotherapy cycles on oncological outcomes in elders with locally advanced cervical cancer treated with concurrent chemoradiotherapy

“…1 Understanding the clinical outcomes including complications associated with primary treatment of their patients is essential to help physicians make the best decisions about cancer treatment. 22,23 It is, however, difficult to state a conclusion concerning the impact of age on current treatments from prior prospective clinical studies as most such studies excluded or included only small proportions of elderly patients. 21 In previous studies, the rates of elderly patients with LACC treated with RT alone varied from 36% to 67% depending on the definition of 'elder' (cut-off age) and study period.…”

“…Currently, identifying the most effective treatment strategy for elders with cancer is of growing importance, along with the growing increase in life expectancy 1 . Understanding the clinical outcomes including complications associated with primary treatment of their patients is essential to help physicians make the best decisions about cancer treatment 22,23 . It is, however, difficult to state a conclusion concerning the impact of age on current treatments from prior prospective clinical studies as most such studies excluded or included only small proportions of elderly patients 21 .…”

“…These low to medium rates (50–72%) of complete CCRT treatment were also seen in clinical trials, which had stricter protocols 19,20 . For elders with cervical cancer, considerably varying rates of complete CCRT have been reported, ranging from 15.0% to 63.3% 13,21,22 …”

“…19,20 For elders with cervical cancer, considerably varying rates of complete CCRT have been reported, ranging from 15.0% to 63.3%. 13,21,22 Regarding the impact of the number of CMT cycles on oncological outcomes, Nugent et al 15 in a study of 118 general-age patients with LACC treated with CCRT with weekly cisplatin 40 mg/m 2 found a breakpoint of at least 5 but not less than 5 cisplatin cycles in addition to their scheduled RT had an improved overall survival (OS) and a longer disease-free interval. Focusing on elderly patients, there is the only one recent population-based cohort study by Xiang and Kidd, 17 which included 826 patients with cervical cancer who underwent definitive RT, of whom 531 (64%) received cisplatin and 295 (36%) did not.…”