Patterns of Care and Outcome of Elderly Women Diagnosed With Cervical Cancer in the Developing World

Abstract

Scarce data exist about the impact of age in cervical cancer (CC) patients in the developing world. The objective of the current study was to examine the patterns of care and outcome of elderly patients treated in a developing country. Medical records of patients treated from 2006-2009 at the Brazilian National Cancer Institute were reviewed. Patients were divided between women 70 years or older and women younger than 70 years. The χ tests were used and odds ratios were calculated. Survival was examined using the Kaplan-Meier method. Single and multivariate Cox proportional hazards modeling were used. A total of 1482 patients were analyzed: 1339 patients younger than 70 years and 143 patients 70 years or older. A marked difference in treatment was noted, even after stratifying by disease stage. Only 21% of the older patients underwent surgical treatment compared with 27.6% of the younger. After adjusting for confounding variables, the hazard ratio for death from CC in the elderly was 1.05 (95% confidence interval, 0.81-1.36; P = 0.11). These results corroborate previous data from developed countries: elderly patients have more advanced disease at diagnosis, and age is an important factor in the allocation of treatment for patients with CC. Worse outcome seemed to be mainly the result of more advanced stage and treatment allocation rather than age itself.

The long-term outcomes in perimenopausal patients treated for cervical cancer

“…However, in analysing patients who were younger or older than 70 years of age, the authors observed the following relationship: elderly patients have more advanced disease at the time of diagnosis, and this is the factor most indicative of a poorer prognosis. On the other hand, age is an important factor in the allocation of treatment, which also influences overall survival [3]. The classification of the patient for adequate radical therapy is crucial for improving survival.…”

“…Nogueira-Rodrigues et al presented the results of treatment for a large group of patients, including 1339 younger patients and 143 elderly patients, treated for cervical cancer. The overall five-year survival rate among the younger patients was 58.2%, and 48.5% among the older patients (including all stages from FIGO I to IV) [3]. Nevertheless, most of our patients are diagnosed as LACC.…”

“…Nevertheless, most of our patients are diagnosed as LACC. In particular, the poorer prognosis found in older as compared to younger women seems to be related to a more advanced stage of the disease at the time of diagnosis [3]. Unfortunately, a widespread mass screening program for cervical cancer has not yet been instituted in all countries, and this fact may impact the long-term outcomes in postmenopausal and elderly women.…”

“…Another factor, which may also influence the long-term outcome in older patients, is the method of treatment. Postmenopausal and elderly patients with cervical cancer are more often treated using radiotherapy than surgery or radio-chemotherapy [3]. Generally, it is thought that surgery in elderly patients is linked with a greater number of subsequent complications.…”

“…Younger patients between 30 and 40 years of age who are diagnosed with cervical cancer have a better prognosis than the older group. The second peak of incidence, involving patients between 60 and 70 years of age, correlates with a poorer prognosis [3].…”