title: Determinants of Quality Care and Mortality for Patients With Locally Advanced Cervical Cancer in Virginia.
abstract: Outcomes for patients with locally advanced cervical cancer are influenced by receipt of all indicated components of quality care: early diagnosis and receipt of external beam radiation therapy, chemotherapy, and brachytherapy. We performed an observational cohort study to evaluate receipt of quality cancer care and mortality after cancer diagnosis among patients with locally advanced cervical cancer in Virginia.We queried the Virginia state cancer registry to identify patients with International Federation of Gynecology and Obstetrics Stage IB-IVA cervical cancer who were diagnosed during 2002 to 2012. We evaluated the influence of tumor-related, demographic, and geospatial factors on the receipt of indicated therapies and mortality. Treatment quality score of 0 to 3 was defined based upon the extent of receipt of the components of indicated therapy.A total of 1048 patients were identified; 33.1% received all 3 components of treatment and only 54.0% received brachytherapy. Predictors of higher quality score included younger age group versus 66+ years at diagnosis (18-42 odds ratio [OR] = 12.3, 95% confidence interval: 6.6, 23.0; 42-53 OR = 5.6, CI: 3.3, 9.5; 53-66 OR = 5.5, CI: 3.3, 9.1), lower tumor stages versus IVA (IB2 OR = 3.3, CI: 1.8, 6.2; II OR = 2.7, CI: 1.6, 4.5; IIIx OR = 2.1, CI: 1.3, 3.6), and treatment at a high-volume facility (OR 2.2, CI: 1.2, 4.2). Predictors of increased mortality included earlier year of diagnosis, higher tumor stage, treatment at a lower volume facility, and lower treatment quality score.In a cohort of locally advanced cervical cancer patients in Virginia, we identified a low rate of receipt of complete quality care for cervical cancer and a strong effect of facility volume on quality treatment and survival. Further research is needed to develop strategies to improve access to quality treatment and outcomes for cervical cancer.
authors.affiliation: From the Department of Radiation Oncology (TNS), Department of Public Health Sciences (FC, RTA) and Department of Obstetrics and Gynecology (LAC), Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Cantrell
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D019984:Quality Indicators, Health Care; D012042:Registries; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D014768:Virginia / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents