The rapid uptake of concurrent chemotherapy for cervix cancer patients treated with curative radiation.
OBJECTIVE
In 1999, a series of clinical trials along with a clinical announcement from the National Cancer Institute (NCI) suggested that chemotherapy should be used concurrently with pelvic radiation in the management of cervical cancer. The purpose of this study is to examine the rate of chemotherapy use, in the province of Ontario, before and after these publications.


METHODS
All incident cases of cervix cancer diagnosed between January 1, 1995, and March 31, 2001, were identified using the provincial cancer registry. These records were electronically linked to billing claims data and inpatient discharge abstract data. Patients receiving brachytherapy within 6 months of diagnosis were identified. The proportion receiving at least one injection of chemotherapy before brachytherapy was identified and compared in the "pre" and "post" publication group (April 1, 1999, cutoff).


RESULTS
We identified 1039 cases as receiving curative radiation. In the pre cohort, 9.4% of patients received chemotherapy (95% CI, 7.3-11.4%) vs. 67.4% in the post cohort (95% CI, 61.8-73.0%). The change occurred abruptly in the first quarter of 1999.


CONCLUSIONS
There was a significant increase in chemotherapy use after the publication of the NCI alert and related trials. Reasons for rapid uptake are discussed.
Barbera
Lisa
L
Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada. lisa.barbera@sw.ca
Paszat
Lawrence
L
Thomas
Gillian
G
Covens
Al
A
Fyles
Anthony
A
Elit
Laurie
L
Qiu
Feng
F
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009864:Ontario; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000401:mortality