Cervical cancer treatment depends on patient age

Dec. 28, 2004 -- Elderly women with cervical cancer face double jeopardy. Not only does their advanced age decrease chances of survival, it also decreases the likelihood that they'll be given the most aggressive treatments for their disease, according to a study by researchers at Washington University School of Medicine in St. Louis.

The study is reported in the Jan. 1, 2005 issue of the journal Cancer.

"The aging of the U.S. population has increased interest in treatments for geriatric cancer patients, but there is very little data about treatment of cervical cancer in the elderly," says first author Jason Wright, M.D., a Washington University gynecological oncologist and part of a team of investigators associated with the Siteman Cancer Center.

A recent report issued by the National Cancer Institute showed that women ages 65 and older die from cervical cancer at a rate of 7.6 per 100,000, compared to 2.1 for women younger than 65.

The Washington University researchers analyzed medical records of more than 1,500 patients treated for invasive cervical cancer at Barnes-Jewish Hospital and the Siteman Cancer Center between 1986 and 2003. They divided the records into two categories, women younger than 70 and women 70 or older.

Their study showed that regardless of the stage of tumor development, elderly patients were likely to receive less aggressive treatment. Surgery was used to treat 16 percent of the elderly group, whereas 54 percent the younger patients underwent surgery. The remainder of the patients were treated with radiation without surgery.

For women treated with radiation therapy alone, the chances of surviving were five times lower than for those treated surgically. Elderly women treated with radiation were given lower doses on average, and they were nine times more likely to forego treatment altogether.

Treatment choices were not the only factors to affect survival; the stage of tumor advancement and the presence of other medical conditions also influenced outcomes. But, this study showed that advanced age itself, for as yet undefined reasons, was a factor that strongly affected survival, independent of the other factors. Women over 70 with cervical cancer had about 1.6 times the risk of death as did comparable women under 70 having the same tumor stage, type of treatment and additional medical diseases.

According to Wright, the effect of advanced age is an important consideration for physicians treating cervical cancer patients. "It may be that physicians are influenced by the presence of other medical conditions when choosing treatments for elderly patients," he says. "But, other studies have shown that elderly patients tolerate radiation therapy and aggressive surgical therapy well, so in light of the age-related risk from cancer, physicians should give greater thought to recommending aggressive treatment."

Next the researchers will study the effect of the presence of other medical conditions on the treatment of cervical cancer. They are also analyzing the type of treatments given to adolescents with abnormal pap smears.

Wright JD, Gibb RK, Geevarghese S, Powell MA, Herzog TJ, Mutch DG, Grigsby PW, Gao F, Trinkaus KM, Rader JS. 2005. Cervical carcinoma in the elderly: An analysis of patterns of care and outcome. Cancer 103(1): 85-91.

Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.