Cervical cancer care poorer at small centers

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Women with cervical cancer who get radiation therapy at small, local facilities are less likely to be treated effectively, researchers report.

Invasive cervical cancer has become relatively rare in the US, with about 12,000 patients diagnosed with the disease each year, Dr. Patricia J. Eifel and colleagues point out. On the other hand, they add, treatment has become complex, raising the issue of whether centers treating only a handful of patients each year have the skills and resources necessary to provide the best treatment.

The researchers evaluated the care received by 442 women treated at 55 US centers between 1996 and 1999. The centers were divided into two groups: those treating 500 or more cervical cancer patients each year, and those treating fewer than 500 patients annually.

The team estimates that, nationwide, half of the facilities treat an average of two or fewer patients with the disease each year.

Shorter, more aggressive courses of radiation are now understood to be more effective for treating invasive cervical cancer. However, Eifel—at the M. D. Anderson Cancer Center in Houston—and her colleagues found that patients treated at the smaller facilities were more likely to get a relative low total radiation dose and to undergo prolonged treatment.

They also were more likely to have undergone hysterectomy and chemotherapy, both of which are not proven to aid in survival, according to the team’s report in the medical journal Radiation Oncology, Biology, Physics.

Overall, the researchers conclude that “some small facilities may lack the resources needed to deliver optimal care to patients, and that they “should consider referring patients to larger facilities for treatment.”

SOURCE: Radiation Oncology, Biology, Physics; November 15, 2004.

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