Patterns of cervical cancer care in Argentina: Applying ASCO recommendations adjusted by local resources

Abstract

There are significant differences in cervical cancer incidence and mortality between low-middle and high-income countries. The American Society of Clinical Oncology (ASCO) resource-stratified clinical practice guideline was designed to provide an appropriate cervical cancer treatment based on the best available evidence in scenarios with different diagnostic and therapeutic resources. Argentina, a Latin American high middle income country, shows however, that cervical cancer rates are similar to those of low-income countries. In addition, significant disparities in incidence and mortality are described throughout the country. The present article describes the current pattern of care of cervical cancer in Argentina and establishes recommendations adjusted to local resources in different regions of the country according to the ASCO guideline.

Global challenges of radiotherapy for the treatment of locally advanced cervical cancer

“…For example, although China has made strides in increasing the overall ratio of radiotherapy facilities per million people (0.75 in 2006 to 1.49 in 2015), these resources are limited in rural areas like Ningxia (0.87 radiotherapy facilities per million people); by contrast, in modern cities like Beijing (3.07 radiotherapy facilities per million people), advanced treatment is available and delivered in an appropriate timeframe 37. Similar trends in regional density of facilities have been reported in Argentina and India 38 39…”

Comparison of global treatment guidelines for locally advanced cervical cancer to optimize best care practices: A systematic and scoping review

“…Gambia is working to increase the number of doctors trained to perform RT, and planned to train 2 doctors in 2018 [37]. In guidelines from Argentina and India, limited access to RT was a reason to provide neoadjuvant chemotherapy and prevent delays in treatment [18,46]. India and Belize also noted that there may be limited availability of MRI facilities for diagnosis and staging [17,18].…”

“…Both the ASCO and IAEA guidelines included in the SLR provide recommendations for resource-limited settings based on expert consensus, allowing healthcare providers to select the best treatment among available options [41,46,50]. Moreover, some countries support the use of alternative therapies for LACC, such as the addition of gemcitabine to cisplatin-based cCRT followed by adjuvant gemcitabine or neoadjuvant therapy [9,18,35,38].…”

“…Eight guidelines discussed neoadjuvant therapy specifically for stage IIB (Table 3), a general recommendation for in Vietnam (VMoH) [35] and against in China [NHC-PRC], India [INC], and Russia [ARNU] guidelines [18,21,30]. It was considered an option in Mexico (ONCO) guidelines [43] and for bulky tumors or when RT is unavailable in Argentina (ASCO) and Belize (MHB) guidelines [17,46], and was up to the discretion of the clinician in Japan (JSCO) [24].…”

Cervical cancer burden in Latin America and the Caribbean: Where are we?

“…Furthermore, intra-country variations in cervical cancer incidence are also observed in most countries/territories; in Argentina, the highest rates were observed in El Chaco, which is one of the provinces in Argentina with a lower HDI 24 . Thus the marked differences in economic development and inequalities in access to screening may also potentially contribute to the disparities in cervical cancer incidence rates 25,26 .…”