Patterns of care for cervical cancer patients treated in the U.S. military health care system.
OBJECTIVE
To determine whether women diagnosed with cervical cancer within the U.S. Department of Defense (DOD) Military Health Care System received treatment within standard guidelines and whether survival was influenced by implementation of these guidelines.


METHODS
We identified 621 women treated from 1994 to 2002. Guideline therapy was defined as hysterectomy or radiation for FIGO stage < or = IB, and hysterectomy or chemoradiation for advanced localized FIGO stage > IB. Survival analysis was performed using Cox Proportional Hazards models.


RESULTS
Of those 621 women, 25% received no surgery, while 41% received radiation therapy. 6% of all patients received chemoradiation therapy prior to the Clinical Announcement received versus 26% of patients after the announcement. Variables associated with significant increased risk of death were advanced age, advanced stage and poorly differentiated lesions, p < 0.01. The lack of guideline therapy was associated with an increased risk of death, p < 0.005. Those patients who did not receive guideline therapy were twice as likely to die (HR 2.11, p = 0.005).


CONCLUSIONS
Our study suggests that chemoradiation was rapidly introduced in the DOD care system after the 1999 National Cancer Institute's Clinical Announcement. However, some patients did not receive guideline therapy.
Farley
John H
JH
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. john.farley@amedd.army.mil
Harlan
Linda C
LC
Clegg
Limin X
LX
Larsen
Wilma I
WI
Trimble
Edward L
EL
D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D008887:Military Medicine / Q000592:standards*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*