Feasibility of Concurrent Chemoradiation in Cervical Cancer Patients From Rural Background

Abstract

There is paucity of literature about tolerability of standard chemoradiation in cervical cancer patients of rural background; hence, we undertook this study. Enteritis and dyselectrolytemias were the most common toxicities and the key reasons for radiation interruption and suboptimal chemotherapy doses. Nutritional and social support along with vigorous assessment for dyselectrolytemias and timely management is the key to optimizing treatment. Background: Concurrent chemoradiation causes toxicities such as enteritis, hematologic toxicities which may lead to treatment interruptions, and therefore inferior outcomes. Adequate supportive care is very important to complete the scheduled protocol. Most of our patients are from rural background with a heterogeneous social background (nutrition and social support). There is paucity of literature to evaluate the tolerance of this intense treatment in these groups of patients, and hence, this study was undertaken. Methods: In this observational study, 30 rural women having carcinoma cervix treated with concurrent chemoradiation between January and July 2013 were reviewed retrospectively. They were assessed weekly for dyselectrolytemia, enteritis, and hematologic toxicity using Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria. Treatment gaps along with reasons were recorded and correlated. Results: Median age of patients was 54 years. Of the patients, 43.3% were International Federation of Gynecology and Obstetrics stage II and 46.7% stage III. Grade 3 enteritis was seen in 7 of 30 patients (23.3%). None (0%) had grade 3 or higher hematologic toxicity. Dyselectrolytemiaehyponatremia (46.66%), hypokalemia (26.66%), hypocalcemia (6.66%), and hypomagnesemia (10%) were noted. Two of thirty patients (6.66%) received the planned 5 cycles, cisplatin 40 mg/m 2 weekly. There were treatment interruptions in radiation in 6 (20%) and treatment delays in chemotherapy in 10 (33.33%) patients. Conclusion: Concurrent chemoradiation for patients from rural areas is associated with higher acute toxicities. Regular monitoring for enteritis and dyselectrolytemias and timely intervention can help improve compliance and decrease treatment interruptions and thereby achieve the optimum treatment outcome.

Utilization and Impact of a Radiation Nursing Clinic to Address Acute Care Needs for Patients with Gynecologic Cancers

“…Our data also showed no correlation between distance from the cancer centre and RNC utilization. Another study has shown that patients from rural backgrounds receiving CCR for cancer of the cervix experience greater acute toxicities [ 35 ]. Given that nearly all patients in our study lived within 100 km of the cancer centre, which is a large tertiary care centre, we may be under-representing this vulnerable population in our study; future work is recommended to identify their supportive care needs.…”

Global Collaborations for Cervical Cancer: Can the East–West Alliance Facilitate Treatment for all?

“…Poor compliance and enhanced acute toxicity are reported in patients from a rural and underprivileged background in LMICs [34]. Audits from developing countries report 42e85% compliance to planned chemoradiation schedules, with a substantial majority of patients receiving less than five cycles of concurrent chemotherapy [29,35,36].…”

National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer

“… 33 Another study from rural India reported poor compliance, higher grade III toxicity, and treatment breaks. 44 Up to 16% to 20% of patients had treatment gaps as a result of toxicity and received three or fewer cycles, which reduced the cumulative dose to 152 mg/m 2 (80 to 200 mg/m 2 ) rather than the desired cisplatin dose of 225 to 250 mg/m 2 . 33 , 45 In patients with coexisting HIV infection, potential interactions between antiretroviral drugs and cancer therapy should be considered, and higher toxicity and poor outcomes 46 may be anticipated.…”