br Progression free survival PFS and overall
Progression free survival (PFS) and overall survival (OS) were calcu-lated using Kaplan Meier curves and p values estimated using log-rank tests. PFS and OS were calculated from the date of diagnosis.
Demographic analysis of the two groups was performed. A signifi-cant difference in age was noted between the two groups with patients receiving all or part of their RT at an OLF being significantly older (59.1
Tumor characteristics and stage were also similar between the two subgroups. A majority of tumors were squamous cell histology account-ing for 80% (n = 20) of patients in the group who received part of their RT at an OLF and 84.0% (n = 63) of patients who received all of their RT at the PI. Tumor grade was also similar between the two groups (p = 0.929) with most tumors falling into the category of moderately to poorly-differentiated. The rate of concern for Y-27632 node involvement
Fig. 1. Study Flowchart.
Patient demographics and tumor characteristics.
BT at OLF
BT at PI
BT at PI
(n = 75) p-value Characteristic
Insurance coverage at diagnosis, n (%)
recommended 60 days than patients who had all or part of their radia-
who underwent all of their RT at the PI also completed their course of
radiation therapy an average of 16.4 days sooner than patients who re-
Progression free survival (PFS) was improved in patients who
underwent all of their RT at the PI, however, this difference was not sta-
Overall survival (OS) was significantly improved in patients who re-
Median follow-up times were similar between the two groups with
a median follow-up of 1099 days for patients who received a portion of
their therapy at an OLF compared to a median follow up of 1573 days for
This study demonstrated that patients who received all of their RT at
on imaging was higher in patients who received all or part of their radi- one facility had a higher compliance rate (completion of radiation ther-
ation therapy at an OLF (48% versus 27%), however, this did not reach apy in ≤60 days) than patients who received all or part of their radiation
statistical significance (p = 0.082). Patients who received all or part of therapy at an OLF. Overall, patients who received all of their RT at the PI
their RT at an OLF did have predominantly more advanced stage disease finished their therapy an average of 16.4 days sooner than patients who
with 48% of patients having Stage III-Stage IVA disease compared to 32% received RT elsewhere. All patients treated at the primary facility com-
of patients who received all of their RT at the PI. These differences did pleted radiation in b10 weeks whereas patients who had treatment at
not meet statistical significance.
outside facilities took up to 13 weeks.
Patients who underwent all or part of their RT at an OLF lived signif- Several studies have demonstrated that toxicity-related delays are
p ≤ 0.001) to the facility providing EBRT but significantly further (mean 20–57.4% of delayed therapy. However, the second most common
BT facility when compared to patients who received all of their RT at the Table 3
PI. The total mean dose of EBRT was similar between the two groups Patient outcomes.
BT at OLF
BT at PI
4.7; p = 0.278). The administration of concurrent chemotherapy was Characteristic
also similar between both groups with a rate of approximately 92.3%
in the group who received all or part of their RT at an OLF and a rate
Patients who underwent all of their radiation therapy at the PI were Median follow-up time in days (from 1099 1573 0.106
more likely to complete their radiation therapy within the time of diagnosis to last follow-up)
Fig. 2. Progression Free Survival; OLF: outlying facility; PI: primary institution.
cause of delayed therapy was secondary to patient non-compliance ac-counting for 7–11.5% of delays in treatment [10,11].
Our finding that many patients do not complete radiation within the suggested guidelines is not unexpected. Overall compliance rates for all types of cancer for RT are lower than other cancer treatment modalities such as surgery and chemotherapy . Cervical cancer, in particular, was also a statistically significant predictor of noncompliance . Other predictors of noncompliance included treatment during winter months, low socioeconomic status, and use of a long treatment course . Previous studies have demonstrated several factors that have a sta-tistically significant impact on adherence to clinical practice guidelines for cervical cancer including age, stage of cancer and distance to treat-ment facility . The small, retrospective nature of this study makes it difficult to detect other factors; alternatively completing radiation out-side of the PI may outweigh other factors. In addition, there are several other factors that could affect completion of therapy that were not spe-cifically addressed in this study such as lower socioeconomic status, caregiver support, and several other comorbidities.