Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline

Abstract

PurposeTo provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer.MethodsASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines.ResultsFive existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater.RecommendationsClinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Cervical cancer: A global health crisis

“…47 The NCCN guidelines provided evidencebased recommendations by the representatives from NCCN member institutions. 68 Included in Table 1 are the 4 resource settings, which included a basic setting, in which bare essential services are available to provide gynecologic cancer care. Recommendations were made regarding the management of patients with cervical cancer based on 4 different resource stratifications (Table 1).…”

Impact of Human Immunodeficiency Virus Infection on Survival and Acute Toxicities From Chemoradiation Therapy for Cervical Cancer Patients in a Limited-Resource Setting

“…Treatment of locally advanced cervical cancer with radiation therapy given concurrently with cisplatin-based chemotherapy has become the global standard (13–15). However, the outcomes of curative chemoradiation therapy (CRT) among HIV-infected patients are not well described.…”

Cervical cancer prevention and treatment in Latin America

“…This strategy was also recently evaluated in the National Institute of Neoplastic Diseases (INEN) in Peru with promising preliminary results . For these reasons, neoadjuvant chemotherapy followed by surgery should continue to be evaluated as an alternative in areas where safe and effective chemoradition is not available …”