Improved Survival in Cervical Cancer Patients Receiving Care at National Cancer Institute-Designated Cancer Centers

For a cancer center to receive National Cancer Institute (NCI) designation, it must undergo a rigorous review process and demonstrate comprehensive cancer care and quality. Treatment at an NCI-designated cancer center (NCICC) has been shown to improve survival in lung, breast, gastrointestinal, ovarian, and bladder cancers. It is currently unknown whether this survival advantage extends to those diagnosed with cervical cancer. Also unknown is whether the use of brachytherapy (BT), a standard-of-care treatment for locally advanced cervical cancer associated with improved survival, might be associated with receiving care at an NCICC. The aims of this retrospective study were to evaluate whether receiving care at an NCICC was associated with improved cancer-specific outcomes among patients in California and whether concurrent chemotherapy and radiation with a BT boost, defined as guideline-concordant treatment, explained that association. Patients diagnosed with primary invasive cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) between January 2004 and December 2016 who subsequently received radiation as part of the first course of treatment were identified using the California Cancer Registry. Information on patient demographics, radiation therapy, and outcomes was obtained from the California Cancer Registry. The primary outcome was cervical cancer-specific mortality, and a Kaplan-Meier plot and age-adjusted Cox proportional hazards model were used to compare cancer-specific survival by care at an NCICC and to assess whether any association remained true while adjusting for confounding and the receipt of guideline-concordant treatment. A total of 5260 patients were eligible for analysis. The cohort had a median age of 50 years (interquartile range, 41-61 years) and mean follow-up time of 2.7 years (interquartile range, 1.3-6.0 years), 33% received care at an NCICC, and 29% died of cervical cancer during the follow-up period. Those receiving care at NCICCs were more likely to be alive, were younger, were less likely to be Black and more likely to be Asian/Pacific Islander, and were more likely to receive chemotherapy, BT boost, and the combination of both compared with those receiving care elsewhere. After adjusting for confounders, patients who received care at an NCICC had a statistically significant survival benefit over those seen elsewhere (hazard ratio of death, 0.81; 95% confidence interval, 0.72-0.92). Adjusting for guideline-concordant treatment received at any center attenuated the hazard ratio to 0.83 (95% confidence interval, 0.74-0.95). The results of this study suggest that patients receiving care at an NCICC had a 20% lower risk of cervical cancer-specific mortality compared with those receiving care elsewhere. This association remained significant even when controlling for known confounders and receiving treatment with a guideline-concordant regimen.