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. 2022 Oct 1;128(19):3479-3486.
doi: 10.1002/cncr.34404. Epub 2022 Aug 2.

Improved survival in cervical cancer patients receiving care at National Cancer Institute-designated cancer centers

Corinne McDaniels-Davidson  1 , Christine H Feng  2 , Maria Elena Martinez  2   3 , Alison J Canchola  4 , Scarlett Lin Gomez  4   5 , Jesse N Nodora  2   3 , Sandip P Patel  2 , Arno J Mundt  2 , Jyoti S Mayadev  2
Affiliations

Improved survival in cervical cancer patients receiving care at National Cancer Institute-designated cancer centers

Corinne McDaniels-Davidson et al. Cancer. .

Abstract

Background: Locally advanced cervical cancer (CC) remains lethal in the United States. We investigate the effect of receiving care at an National Cancer Institute-designated cancer center (NCICC) on survival.

Methods: Data for women diagnosed with CC from 2004 to 2016 who received radiation treatment were extracted from the California Cancer Registry (n = 4250). Cox proportional hazards regression models assessed whether (1) receiving care at NCICCs was associated with risk of CC-specific death, (2) this association remained after multivariable adjustment for age, race/ethnicity, and insurance status, and (3) this association was explained by receipt of guideline-concordant treatment.

Results: Median age was 50 years (interquartile range [IQR] 41-61 years), with median follow-up of 2.7 years (IQR 1.3-6.0 years). One-third of patients were seen at an NCICC, and 29% died of CC. The hazard of CC-specific death was reduced by 20% for those receiving care at NCICCs compared with patients receiving care elsewhere (HR = .80; 95% CI, 0.70-0.90). Adjustment for guideline-concordant treatment and other covariates minimally attenuated the association to 0.83 (95% CI, 0.74-0.95), suggesting that the survival advantage associated with care at NCICCs may not be due to receipt of guideline-concordant treatment.

Conclusions: This study demonstrates survival benefit for patients receiving care at NCICCs compared with those receiving care elsewhere that is not explained by differences in guideline-concordant care. Structural, organizational, or provider characteristics and differences in patients receiving care at centers with and without NCI designation could explain observed associations. Further understanding of these factors will promote equality across oncology care facilities and survival equity for patients with CC.

Keywords: California; brachytherapy; cancer center; cervical cancer; treatment outcome; uterine cervical neoplasms.

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Conflict of interest statement

Jyoti S. Mayadev reports consulting honoraria from Varian Medical Systems, Merck, Astra Zeneca, and Primmune Bio and grants from NCI, NRG Oncology, and GOG Foundation. The other authors made no disclosure.

Figures

FIGURE 1
FIGURE 1
Hypothesized directed acyclic graph of the association between care at a National Cancer Institute–designated cancer center and reduced mortality from cervical cancer.
FIGURE 2
FIGURE 2
Cervical cancer–specific survival among patients diagnosed with IB2‐IVA cervical cancer in California between 2004 and 2016 by whether received care at a National Cancer Institute–designated cancer center (n = 4250).
See this image and copyright information in PMC

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