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Comorbidity and age affect treatment policy for cervical cancer: a population-based study in the south of the Netherlands, 1995-2004
M. A. van der Aa1,*, S. Siesling1, R. F. P. M. Kruitwagen2,3, M. L. M. Lybeert4, J. W. W. Coebergh5,6, M. L. G. Janssen-Heijnen2
1 Comprehensive Cancer Centre North East, Enschede
2 Department of Gynaecology, TweeSteden Hospital, Tilburg
3 Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen
4 Department of Radiotherapy, Catharina Hospital, Eindhoven
5 Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven
6 Department of Public Health, Erasmus University Medical Centre, Rotterdam (The Netherlands)
Eur. J. Gynaecol. Oncol. 2008, 29(5), 493–498;
Published: 10 October 2008
Objective. The aim of this study was to estimate the effects of age and comorbidity on the choice of treatment modalities and prognosis for patients with cervical cancer. Methods. All patients with cervical cancer newly diagnosed between 1995 and 2004 (n = 775) were selected from the population-based Eindhoven Cancer Registry. Time trends in treatment modalities and differences in treatment between older and younger patients, and those with and without comorbidity were evaluated. Results. Older patients with FIGO Stages IB-IIA, elderly and those with comorbidity underwent less surgery. In multivariate survival analysis, age had independent prognostic value. For patients with FIGO Stages IB2, IIB-IVA, age affected the choice of chemoradiation significantly. According to multivariate survival analysis, comorbidity and FIGO stage were independent prognostic factors. Conclusion. Older patients with cervical cancer and those with comorbidity were treated less aggressively. Because of the ever-increasing role of comorbidity in clinical decision-making for increasingly older patients in the near future, development of age-specific guidelines incorporating levels and management of specific comorbidity seems warranted.