Survival Analysis of Women Diagnosed with Cervical Cancer in Evaluation of 1999 National Cancer Institute Treatment Guidelines

Includes bibliographical references (pages 26-29).Background: In 1999, the National Cancer Institute (NCI) underwent a large campaign targeting physicians to implement a treatment update for women diagnosed with localized or regionalized stage cervical cancer. The update recommended a combination of chemotherapy and radiation therapy after six longitudinal studies showed that treatment predicted greater survival than chemotherapy or radiation therapy alone. This analysis assessed whether cervical cancer-specific survival was greater before or after the implementation of the NCI update among women who participated in the SEER program, who had some form of radiation therapy. This analysis also assessed whether there was a difference in survival among black women and other women versus white women. \ud Methods: The Kaplan-Meier method was used to evaluate the survival curves of each variable, then Cox-Proportional Hazards model determined the risk of cervical cancer-specific death in relation to each variable. Proportional Hazards assumption was tested and met. Results: 12,001 women met the selection criteria. After adjusting for stage and age at diagnosis, race, cancer-directed surgery, and registry, women who were diagnosed between the years 1975-1998 were 29% more likely to die (Hazard Ratio [HR]: 1.29; 95% Confidence Interval [CI]: 120, 138) when compared to women who were diagnosed between the years 1999-2010. Black women were 16% more likely to die (HR: 1.16; 95% CI: 1.07, 1.27) when compared to white women. Conclusion: These findings suggest that there is a temporal link between the National Cancer Institute???s treatment guideline update and the improved survival of women diagnosed after the year 1999. Also, there was a disparity in survival for black women when compared to white women that needs to be explored further. A study using chemo-radiation as an exposure variable is ultimately needed to assess and strengthen these findings on the impact of the NCI???s treatment guidelines