Presenter(s)
A. Puthran1, R. Miller2, and J. A. Holmes2; 1Indiana University School of Medicine, Indianapolis, IN, 2Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
Purpose/Objective(s): Aggressive medical intervention near the end of life often incurs high costs with minimal benefit to patient quality of life. While recent clinical trials have demonstrated a survival benefit to chemotherapy and immunotherapy in metastatic cervical cancer, participants in these trials generally had an excellent performance status and a life expectancy of at least several months. This study investigates trends in chemo/immunotherapy and radiation for patients with metastatic cervical cancer, and whether there has been a shift away from palliative radiation toward more aggressive use of immunotherapy in patients with a very poor prognosis.
Materials/Methods: A retrospective analysis was conducted using the National Cancer Database. The study population included all patients diagnosed with metastatic cervical cancer between 2015 and 2022. Outcomes were analyzed for the total cohort and specifically for a subset of patients who died within 90 days of diagnosis (DWND) – a proxy for poor prognosis/performance status and end of life care.
Results: The study identified 10,285 patients with metastatic cervical cancer, of whom 2,399 (23.3%) died within 90 days of diagnosis. Throughout the study period, chemotherapy use remained stable for both the overall population (~69%) and the DWND group (~24%). In contrast, immunotherapy use saw a significant increase, rising from 11% in 2014 to 44% in 2022 for all patients, and from 0% to 12% in the DWND group. Notably, the use of radiation therapy showed a downward trend in both groups. In the DWND cohort, any radiation use fell from 37% to 21%.
Conclusion: While treatment patterns for chemotherapy and immunotherapy generally align with current guideline-recommended therapy for otherwise healthy patients with metastatic disease, there is a concerning trend toward increased immunotherapy use in patients with a very poor prognosis – the group of patients least likely to derive a survival or quality of life benefit from this treatment. Conversely, the utilization of radiation therapy has decreased among patients who DWND, a patient population that is often profoundly symptomatic near the end of life. These findings highlight the importance of further discussion regarding the relative value of treatment options near the end of life for patients with a poor prognosis.
| Metastatic Cervical Cancer | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
| All patients, n | 1,089 | 1,119 | 1,100 | 1,215 | 1,171 | 1,108 | 1,083 | 1,195 | 1,205 |
| Chemo | 69% | 69% | 69% | 69% | 68% | 69% | 70% | 66% | 70% |
| Immuno | 11% | 15% | 19% | 19% | 27% | 30% | 30% | 38% | 44% |
| Any rads | 54% | 53% | 49% | 50% | 52% | 47% | 48% | 41% | 42% |
| >15 fxs rads | 30% | 26% | 25% | 26% | 26% | 22% | 23% | 18% | 18% |
| Death within 90 days, n | 261 | 264 | 275 | 252 | 269 | 265 | 233 | 298 | 282 |
| Chemo | 25% | 23% | 22% | 25% | 25% | 22% | 27% | 25% | 22% |
| Immuno | 0% | 1% | 4% | 4% | 5% | 8% | 9% | 10% | 12% |
| Any rads | 37% | 34% | 33% | 31% | 29% | 28% | 26% | 26% | 21% |
| >15 fxs rads | 9% | 5% | 4% | 3% | 2% | 2% | 3% | 3% | 2% |