Abstract
Objective
Treatment time has been used as a benchmark of quality care for women receiving primary concurrent chemoradiation (CCRT) for locally advanced cervical cancer. We assessed adherence to this quality measure and the impact of delays in therapy on clinical outcomes.
Methods
This retrospective review included patients treated with CCRT for cervical cancer between January 2000 and June 2014. Primary outcome was adherence to the quality measure of completion of therapy ≤56 days. Secondary outcomes include treatment times, response, recurrence, progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS).
Results
Of the 201 patients included, 90 (44.8%) completed therapy ≤56 days. There were no differences in baseline characteristics for patients completing therapy in ≤56 days versus >56 days. External beam radiation therapy (EBRT) at a local/non-academic facility, prolonged time to complete EBRT, and longer time to initiation of brachytherapy (BT) were associated with total treatment time prolongation. No significant differences in response, recurrence, PFS, DSS, or OS were observed with respect to total treatment time; however, protracted time to complete EBRT was associated with decreased PFS and DSS.
Conclusions
More than 50% of patients treated with primary CCRT for locally advanced cervical cancer fail to meet the quality benchmark for timely completion of therapy. Location of treatment, time to completion of EBRT, and delay in initiation of BT was associated with treatment prolongation. Though total treatment time failed to correlate with disease-specific outcomes, treatment delays during EBRT were detrimental to PFS and DSS.
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