Age-specific differences in the treatment of cervical cancer in the east and the south of The Netherlands 1989-2004.
OBJECTIVE
This study aims to describe trends and variation in treatment and survival of cervical cancer in two regions in The Netherlands and to relate this to adherence to the treatment recommendations.


METHODS
Patient characteristics, tumour characteristics, treatment and follow-up data were collected for 1954 cervical cancer cases diagnosed in the period 1989-2004.


RESULTS
In FIGO stages IB-IIA 93% of patients were treated according to the recommendations of The Netherlands Working Group Gynaecologic Oncology. Older patients received radiotherapy more often than younger patients: 48% (95%CI 40-57) of patients older than 70 compared to 15% (95%CI 10-20) of patients aged 50-69 and 5% (95%CI 3-7) of patients aged 50 or younger (p<0.05). In FIGO stages IIB-IVA 76% of patients were treated according to the recommendations of the Working Group. Chemoradiation was given to older patients less often than to younger patients: 2% (95%CI 0.5-5) versus 23% (95%CI 16-29). A decreased risk of death was found for patients receiving chemoradiation (RER 0.6, 95%CI 0.3-0.9) compared to those receiving "radiotherapy only".


CONCLUSIONS
Far from being always followed, the treatment recommendations were better implemented for treatment of patients with FIGO IB-IIA. Elderly patients received different treatment compared to younger patients in this study and showed an independent increased risk of death in the lower stages, which confirms that the need becomes stronger for paying attention to treatment of elderly patients.
van der Aa
Maaike A
MA
Comprehensive Cancer Centre North East, Enschede/Groningen, The Netherlands. m.vanderaa@ikno.nl
Siesling
Sabine
S
v d Poll-Franse
Lonneke V
LV
Schutter
Eltjo M
EM
Lybeert
Marnix L
ML
Coebergh
Jan Willem W
JW
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*