Cervical cancer outcomes with the elimination of access to care disparities.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17585-e17585
Author(s):  
Maliha Agloria ◽  
Faisal Cheema ◽  
Gary Von Burton ◽  
Glenn Morris Mills ◽  
Runhua Shi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Racial Disparities ◽  
Figo Stage ◽  
Clinical Staging ◽  
Treatment Center ◽  
Rank Test ◽  
Cancer Center ◽  
Future Research ◽  
Treatment Standards ◽  
Recommended Treatment

e17585 Background: Previous studies suggest lack of insurance and quality of care variations may drive disparities in cervical cancer (CC) survival, while equitable care may close these gaps. SEER based CC mortality between 2005-9 amongst white (W) and black (B) patients (pts) was 2.2 and 4.3/100,000 respectively. To define the role of equitable care on racial disparities we selected a population of pts with CC treated irrespective of the insurance status at the Feist-Weiller Cancer Center (FWCC). We hypothesized that disparities would be less pronounced at FWCC due to equitable care. Methods: A retrospective cohort study of 151 pts with FIGO Stage I-IV cervical cancer who had clinical staging, PET imaging and treatment at FWCC between 2005-9. Collected information included age, race, date of diagnosis, histology, stage, retroperitoneal lymph node (RPLN) status, treatment received, distance from the cancer center and payer status. The treatment parameters and outcomes were compared between ethnic and financial groups. Overall survival (OS) was assessed by using the Kaplan-Meier method and compared by log rank test. Results: Patients included 88 B, 66 W and 3 other pts with median age 46 years (23 – 84). Payer status included 45% uninsured, 35% medicaid, 15% medicare, and 5% other insurance. Histological type, stage, distance from treatment center and RPLN were equally distributed between groups. All pts completed standard treatment. There was no difference in PFS (p = 0.80) and OS (p = 0.23) between ethnic groups. In concordance with prior studies the following were associated with decreased OS; non-squamous histology, 15% pts (p=0.05), advanced stage (1b2-IV; p=0.04) and RPLN on imaging, 7% pts (p=0.008). Conclusions: Cervical cancer disparities are differentially distributed across the US hospital systems. There were no disparities identified at our institution relative to payer status with all pts receiving currently recommended treatment standards. Our findings indicate that delivery of equitable care can eliminate survival differences. Future research should assess the effect of emerging Accountable Care Organizations on the elimination of racial disparities in cancer treatment outcomes.

A STUDY ON THE NEOADJUVANT CHEMOTHERAPY WITH CHEMORADIATION VERSUS DEFINITIVE CHEMORADIATION IN LOCALLY ADVANCED STAGE OF CERVICAL CANCER

2021 ◽  
pp. 67-69
Author(s):  
Subhas Haldar ◽  
Archana Dixit ◽  
Dinesh Kumar Saroj ◽  
Debarshi Jana
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Response Rate ◽  
Locally Advanced ◽  
Figo Stage ◽  
Cancer Center ◽  
Open Label ◽  
Randomized Control ◽  
Control Study ◽  
Better Than

Introduction: Ajoint study on cervical cancer prepared by ASSOCHAM-National Institute of Cancer Prevention and Research (NICPR) reveals, India alone accounts for one-fourth of global burden of cervical cancers. To compare the response rate in neoadjuvant chemotherapy arm versus only denitive chemoradiation for cervical stage IIB to IVApatients. Materials and methods: The study involves accrual of patients at the Department of Radiotherapy, Saroj Gupta Cancer center and research institute. Allocation: Prospective, parallel, open label, single institutional randomized control study. Conclusion: We concluded that the response rate in neoadjuvant chemotherapy arm was better than only denitive chemoradiation for cervical FIGO stage IIB to IVApatient

Interobserver Variability of the International Federation of Gynecology and Obstetrics Staging in Cervical Cancer

2013 ◽  
Vol 23 (5) ◽  
pp. 890-894 ◽  
Author(s):  
Philippe Tummers ◽  
Kees Gerestein ◽  
Jan Willem Mens ◽  
Hans Verstraelen ◽  
Helena van Doorn
Keyword(s):  
Cervical Cancer ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
Figo Stage ◽  
International Federation ◽  
Clinical Staging ◽  
Pelvic Examination ◽  
Substantial Agreement ◽  
Gynecology And Obstetrics ◽  
Level Of Agreement

ObjectiveThe objective of this study was to assess the interobserver variability of pelvic examination under anesthesia (EUA) in cervical cancer.MethodsSubsequent patients undergoing a staging procedure under anesthesia for primary cervical cancer were enrolled in the study. All clinicians assessed “blinded” tumor size, and the involvement of vagina, parametria, sacrouterine ligaments, pelvic sidewalls, bladder, and/or rectum. Items were scored varying from 1 (“certainly no involvement”), 2 (“not sure about involvement”), to 3 (”involvement”). Each individual decided on the International Federation of Gynecology and Obstetrics (FIGO) stage; also, the urge for imaging and treatment proposal were accounted for. Final FIGO staging was obtained by consensus of the team. Investigators were classified as experienced after more than 50 EUAs. All others were classified less experienced. The free-marginal κ values between experienced and less experienced investigators were calculated for all previously mentioned items.ResultsBetween February 2009 and December 2010, a total of 86 patients were enrolled. Among experienced investigators, a moderate interobserver agreement was found with regard to FIGO stage (free-marginal κ value of 0.49) and an excellent interobserver agreement on their proposed therapy (free-marginal κ value of 0.84). A lower level of agreement was found when comparing experienced with less experienced investigators: only a slight level of agreement on FIGO stage and a substantial agreement on their therapy proposal (free-marginal κ values of 0.03 and 0.66).ConclusionsWe describe only a moderate interobserver agreement on clinical staging of patients with cervical cancer. The interobserver agreement increases in the group of experienced doctors, indicating that EUA can be learned.

scholarly journals Survival of a cohort of women with cervical cancer diagnosed in a Brazilian cancer center

2011 ◽  
Vol 45 (4) ◽  
pp. 661-667 ◽  
Author(s):  
Claudio Calazan do Carmo ◽  
Ronir Raggio Luiz
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Cox Model ◽  
Tumor Staging ◽  
Invasive Cervical Cancer ◽  
Locally Advanced ◽  
Clinical Staging ◽  
Southeastern Brazil ◽  
Cancer Center

OBJECTIVE: To assess overall survival of women with cervical cancer and describe prognostic factors associated. METHODS: A total of 3,341 cases of invasive cervical cancer diagnosed at the Brazilian Cancer Institute, Rio de Janeiro, southeastern Brazil, between 1999 and 2004 were selected. Clinical and pathological characteristics and follow-up data were collected. There were performed a survival analysis using Kaplan-Meier curves and a multivariate analysis through Cox model. RESULTS: Of all cases analyzed, 68.3% had locally advanced disease at the time of diagnosis. The 5-year overall survival was 48%. After multivariate analysis, tumor staging at diagnosis was the single variable significantly associated with prognosis (p<0.001). There was seen a dose-response relationship between mortality and clinical staging, ranging from 27.8 to 749.6 per 1,000 cases-year in women stage I and IV, respectively. CONCLUSIONS: The study showed that early detection through prevention programs is crucial to increase cervical cancer survival.

scholarly journals The expression of HOXA9 and its prognostic value in cervical cancer

2020 ◽  
Author(s):  
Keqian Zhang ◽  
Tianqi Mao ◽  
Zhicheng He ◽  
Xiaojiao Wu ◽  
Yu Peng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Value ◽  
Cox Regression ◽  
Figo Stage ◽  
Rank Test ◽  
Chi Square ◽  
Cox Regression Analysis ◽  
Normal Tissues ◽  
Kaplan Meier ◽  
Chi Square Test

Abstract Background The HOXA9 gene, belonging to homeobox (HOX) gene family, has been recently reported dys-expressed in several kinds of human cancers. This study aimed to investigate the expression of HOXA9 and its prognostic value in cervical cancer. Methods The HOXA9 mRNA expression was detected with a quantitative real-time polymerase chain reaction (qRT-PCR) assay, and the association of HOXA9 expression with clinical characteristic was analyzed via chi-square test. Kaplan-Meier and cox regression analyses were conducted to estimate the prognostic value of HOXA9 in cervical cancer. Results HOXA9 expression was significantly down-expressed in cervical cancer tissues compared with that in adjacent normal tissues (P < 0.01). And the expression of HOXA9 was significantly associated with TNM stage, pathological grade, FIGO stage and differentiation (All P < 0.05). In addition, Kaplan–Meier analysis indicated that the overall survival of patients with low HOXA9 expression was shorter than those with high HOXA9 expression (log rank test, P = 0.000). Cox regression analysis revealed that HOXA9 had a high prognostic value in cervical cancer. Conclusion HOXA9 is down-regulated and involved in the development of cervical cancer. Moreover, it may be an useful independent prognostic bio-marker for patients with cervical cancer.

Influence of the new FIGO classification for cervical cancer on patients’ survival: Retrospective analysis of 265 histologically confirmed cases with FIGO stages Ia to IIb.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17006-e17006
Author(s):  
Nikolaus de Gregorio ◽  
Amelie De Gregorio ◽  
Florian Ebner ◽  
Fabienne Schochter ◽  
Thomas W. P. Friedl ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Figo Stage ◽  
Tumor Stage ◽  
Primary Treatment ◽  
Rank Test ◽  
Strong Impact ◽  
Stage Ib ◽  
Significant Difference ◽  
Figo Classification

e17006 Background: End of 2018 a new FIGO Classification for cervical cancer was published, mainly revising stage Ib and introducing a new stage IIIc, which includes irrespectively of tumor size and local spread all patients with lymph node metastasis. Methods: We retrospectively analyzed all cases of cervical cancer stage I to IIb who underwent surgery as primary treatment at our institution from 2000 until 2016 and therefore had a histological confirmation of tumor stage. We reclassified all histologies according to the new FIGO classification and calculated outcome parameters according to the new stage. Results: Out of 265 patients, 146 (55%) patients were reclassified into a higher FIGO stage. Most changes appeared within stage Ib and from any stage to stage IIIc1. Kaplan Meier curves for new stages showed a significant difference for stages I vs. II vs. III (log rank test, p < 0.001). Overall, patients that were upstaged had a significant worse PFS (p = 0.012) and OS (p = 0.008) than patients whose stage did not change. Similar observations were made within sub-stages, when node-positive Ib or IIb tumors were upstaged to IIIc tumors. Conclusions: The new FIGO classification for cervical cancer reflects the strong impact of lymph node metastases on survival and is a clear improvement compared to the old FIGO classification with regard to risk stratification.

Surgical Treatment in FIGO Stage I Cervical Cancer: Evolution of Concepts

2007 ◽  
Vol 3 (2) ◽  
pp. 129-137
Author(s):  
Francesco Raspagliesi ◽  
Antonino Ditto ◽  
Francesco Hanozet ◽  
Fabio Martinelli ◽  
Eugenio Solima ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Surgical Treatment ◽  
Figo Stage ◽  
Stage I ◽  
Cancer Evolution

scholarly journals Frequency and Prognosis of Epidermal Growth Factor Receptor Variant III Mutations in Glioblastoma Multiforme among Indian Patients: A Single-Institution Study

2020 ◽  
Vol 09 (03) ◽  
pp. 126-129
Author(s):  
Wesley Mannirathil Jose ◽  
Vinayak Munirathnam ◽  
V. Narendranath ◽  
Arun Philip ◽  
Pavithran Keechilat
Keyword(s):  
Growth Factor ◽  
Glioblastoma Multiforme ◽  
Epidermal Growth Factor ◽  
World Literature ◽  
Mutational Analysis ◽  
Growth Factor Receptor ◽  
Progression Free Survival ◽  
Rank Test ◽  
Cancer Center ◽  
Epidermal Growth

Abstract Background Glioblastoma multiforme (GBM) is a disease with poor outcome. Alterations or mutations in epidermal growth factor receptors (EGFRs) are found in GBM and may be targeted to improve outcomes. Aims We analyzed the frequency of EGFR variant III (vIII) mutations in patients with GBM and their outcomes after standard treatment. Materials and Methods This is a retrospective study conducted in a single tertiary cancer center in south India. Forty patients with GBM who had their entire treatment done at this center were identified, and their primary tumor tissue blocks were retrieved. Genomic DNA was extracted, and molecular analysis was performed and analyzed. The results of mutational analysis were correlated with treatment outcome of the patients. Statistical Analysis Survival outcome was analyzed using the Kaplan–Meier method. The log-rank test was used to assess the association between the groups and various parameters. Results Our study showed a similar incidence of EGFR vIII alterations as published in world literature, but we did not find any difference in overall survival (OS) and progression-free survival (PFS) in patients with EGFR vIII mutation compared with nonmutant cohort. Conclusions Contrary to the existing literature which indicated EGFR vIII alterations to be a negative prognostic indicator, our study did not find it to be an independent predictor of prognosis among Indian GBM patients treated with present standard of care.

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