Recommended treatment linked to longer survival in older cervical cancer patients

Recommended treatment linked to longer survival in older cervical cancer patients | Image Credit: © Chinnapong - © Chinnapong - stock.adobe.com.

Researchers have identified greater survival rates among older patients with early-stage cervical cancer receiving recommended treatment, publishing their findings in JAMA Network Open.¹

Despite guidelines for women aged 21 to 65 years to receive regular screening for cervical cancer, untreated precancerous lesions remain in many women aged 66 years or older, increasing the risk of cancer progression.² Older patients are also more likely to be diagnosed with advanced-stage disease, highlighting a gap in detection and treatment.¹

“Evidence remains limited for early-stage cervical cancer in older patients—a group for whom treatment can be curative but may not be offered or may be declined due to medical, personal, or social factors,” wrote investigators.

Patient characteristics and treatment categories

The study was conducted to evaluate the impact of early detection and adequate treatment on life expectancy in older women with cervical cancer. Data about cervical cancer cases from 2000 to 2020 was obtained from 17 Surveillance Epidemiology and End Results cancer registries.

Cancer statistics available in the database included cancer characteristics, patient demographics, treatment information, and follow-up outcomes. Participants included women aged at least 65 years when first diagnosed with malignant invasive primary cervical cancer at the localized stage.

Categories of age at diagnosis included 65 to 74 years, 75 to 84 years, and at least 85 years. Exclusion criteria included unknown age, diagnosis at age over 99 years, alive without survival time, and missing survival variables.

Treatment patterns across age groups

Surgery was either performed, not recommended, recommended but unknown if performed, recommended but not performed, or unknown. Similar categories, including performed, not performed, or unknown, as well as recommended but unknown if performed, and refused, were reported for radiotherapy. Chemotherapy was not reported as an independent variable.

There were 2236 participants included in the final analysis, 66.3% of whom were aged 65 to 74 years, 25.3% 75 to 84 years, and 8.4% 85 years or older. In the first group, surgery was given to 76.4%, while 1.3% were recommended but did not receive surgery, and 21.5% were not recommended for surgery.

Radiotherapy was provided to 41.4%, not received by 56%, and refused by 1.4%. Chemotherapy was provided to 27.1%. In patients aged 85 years or older, surgery was less often recommended, while radiotherapy was received by 52.9%, not received by 4.8%, and refused by 4.8%. Chemotherapy was only provided to 12.7%.

Survival outcomes by treatment type

The 5-year survival rate in women aged 65 to 74 years was significantly increased when undergoing surgery, at 91.2% vs 69.6% among those not undergo surgery and 52.3% among those who were recommended but did not receive surgery. Undergoing the recommended surgery also had a greater survival rate of 88.6% in women aged 75 to 84 years vs 42.7% for not receiving recommended surgery.

Radiotherapy outcomes were also reported, with survival rates of 79.7%, 53.2%, and 91% among patients aged 65 to 74 years who received radiotherapy, refused radiotherapy, and did not receive radiotherapy, respectively. No significant differences were observed for other age groups.

An adjusted hazard ratio (aHR) of 0.28 was reported for cervical cancer mortality in patients undergoing surgery vs no surgery, highlighting a significant risk reduction. In patients aged 65 to 74 years and 75 to 84 years, the aHRs were 0.37 and 0.20, respectively. Overall, receiving recommended treatment was linked to survival benefits in older women.

“These findings underscore the importance of early detection and the need for personalized treatment approaches that account for the health status, comorbidities, and individual preferences of older patients rather than chronological age,” wrote investigators.

References

1. Suk R, Lin Y, Dilley S, et al. Survival by treatment recommendation and receipt among older patients with early-stage cervical cancer. JAMA Netw Open. 2025;8(9):e2532206. doi:10.1001/jamanetworkopen.2025.32206
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024.CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820