TOPLINE: 

Among women aged 65 years or older with localized cervical cancer, those who underwent recommended surgery or radiation had significantly lower cervical cancer mortality and a higher 5-year survival rate than those who did not undergo, or declined, treatment.

METHODOLOGY: 

• About 20% of cervical cancers among US women are diagnosed after age 65. Early-stage disease in this group can be curable, but treatment may not be offered or may be declined due to medical, personal, or social factors. Understanding the survival benefits of treatment for these patients is essential.
• Researchers conducted a retrospective cohort study of 2236 women aged 65 years or older with a first diagnosis of localized invasive cervical cancer using data from 17 Surveillance, Epidemiology, and End Results (SEER) cancer registries between 2000 and 2020. Most (66.3%) were aged 65-74 years, 25.3% were aged 75-84 years, and 8.4% were 85 years or older.
• Five-year relative survival rates and cervical cancer-specific mortality were estimated according to treatment recommendation and actual receipt of treatment.
• Among patients aged 65-74 years, 76.4% underwent surgery, 1.3% were recommended surgery but did not have it (reasons unknown), and 21.5% did not have surgery recommended to them; 41.4% received radiotherapy, while 56% did not, and 1.4% declined it. Surgery was less common among older patients: Among those aged 75-84 years, 58.6% underwent surgery, while 3.2% were recommended surgery but did not have it, and 37.2% did not have surgery recommended. Those rates were 34.4%, 4.8%, and 56.6%, respectively, among patients aged 85 years or older.

TAKEAWAY:

• Among patients aged 65-74 years, the 5-year relative survival rate was 91.2% for those who underwent recommended surgery vs 69.6% for those not recommended surgery and 52.3% for those who did not undergo recommended surgery. For the same age group, 5-year survival was 91.0% for patients who did not receive radiotherapy vs 79.7% for those who received radiotherapy and 53.2% for those who refused it.
• Among patients aged 75-84 years, undergoing recommended surgery resulted in a significantly higher survival rate than not undergoing recommended surgery (88.6% vs 42.7%). No significant difference was seen in the oldest age group.
• Undergoing vs not undergoing recommended surgery was associated with a significantly decreased risk of cervical cancer mortality among women aged 65-74 years (adjusted hazard ratio [aHR], 0.37) and those aged 75-84 years (aHR, 0.20).
• Among patients aged 65-74 years, those who underwent radiotherapy had a significantly lower risk of cervical cancer mortality vs those who did not receive recommended radiotherapy (aHR, 0.48).

IN PRACTICE:

This study highlights the “significant survival benefits associated with the receipt of recommended treatments in patients aged 65 years or older with early-stage cervical cancer,” the authors wrote. More research is needed, they stressed, to understand the reasons for nonreceipt of recommended treatments: “By addressing the barriers to treatment adherence and optimizing care strategies, we can improve the survival outcomes and overall management of cervical cancer in the aging population.” 

SOURCE:

The study was led by Ryan Suk, PhD, MS, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, and was published online in JAMA Network Open.

LIMITATIONS:

The SEER registry data lacked detailed information on comorbidities and concurrent treatments. The registry did not capture reasons behind treatment refusal or nonreceipt, which may include patient preferences, socioeconomic barriers, or healthcare system limitations. Quality-of-life measures and patient-reported outcomes were not included. 

DISCLOSURES:

The authors did not disclose any funding information and declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.