Survival by Treatment Recommendation and Receipt Among Older Patients With Early-Stage Cervical Cancer

Importance: Cervical cancer remains a substantial public health concern among older women, particularly those who are beyond the age of routine screening. Understanding the survival benefits of treating early-stage cervical cancer in this population is essential for optimizing care and improving outcomes. Objective: To analyze the survival outcomes based on the receipt of treatment and treatment recommendations among patients with early-stage cervical cancer aged 65 years and older. Design, Setting, and Participants: This retrospective cohort study of patients aged 65 years and older with a first diagnosis of localized, microscopically confirmed invasive cervical cancer used data from 17 Surveillance, Epidemiology, and End Results (SEER) cancer registries in the US from 2000 to 2020. Data were analyzed from May 2023 to January 2024. Exposure: Receipt of recommended treatment, specifically surgery and/or radiotherapy, as recorded in the SEER database. Treatment modalities were categorized based on recommendation status and actual receipt. Main Outcomes and Measures: Survival outcomes based on treatment recommendation and receipt status by treatment type expressed as (1) 5-year relative survival rates, (2) cervical cancer-specific mortality, estimated using competing risks models, and (3) adjusted hazard ratios (AHRs) calculated using Fine-Gray competing risk regression. Results: Among 2236 females included in the study, 66.3% (1482) were aged 65 to 74 years, 25.3% (565) were 75 to 84 years, and 8.4% (189) were aged 85 years or older. In the group aged 65 to 74 years, those who received surgery had significantly higher 5-year survival rates (91.2%, 95% CI, 88.4%-93.4%) compared with those not recommended for surgery (69.6%, 95% CI, 62.8%-75.4%) or those who were recommended but did not receive surgery (52.3%, 95% CI, 24.2%-74.3%). Similar patterns were observed in the group aged 75 to 84 years, in which receiving surgery was associated with higher survival rates (88.6%, 95% CI, 79.8%-93.7%). In multivariable analyses, receiving surgery (AHR, 0.28; 95% CI, 0.16-0.50) and radiotherapy (AHR, 0.48; 95% CI, 0.26-0.87) were significantly associated with lower cervical cancer-specific mortality compared with not receiving the recommended treatment. Conclusions and Relevance: In this cohort study, receipt of recommended treatment was associated with higher survival rates among older patients with early-stage cervical cancer. Addressing barriers to treatment adherence and improving early detection and preventive measures in this older population may enhance population health and reduce cervical cancer mortality in the aging population.