br Results This study included patients
Results. This study included 100 patients, 75 of which received all of their RT at the primary institution. These patients were more likely to complete RT within 60 days when compared to patients who underwent RT at dif-ferent facilities (58.7% vs 24%, respectively; p = 0.005). Patients who underwent all of their RT at the primary in-stitution completed their therapy an average of 16.4 days sooner (75.1 ± 21.3 days versus 58.7 ± 13.2 days; p = 0.001). Overall survival was significantly improved in this group (p = 0.03). Conclusion. Women who complete EBRT and BT at different institutions are more likely to have a protracted RT course (N60 days). These patients should be identified at diagnosis and efforts made to coordinate their care to avoid delays in treatment.
The current treatment for locally advanced cervical cancer (Stage IB1-IVA) involves curative external beam Nocodazole therapy (EBRT) with concurrent chemotherapy, followed by intracavitary brachyther-apy (BT). Higher survival rates and local control are achieved when sev-eral quality indicators are applied. These quality indicators are endorsed by the Society of Gynecologic Oncology (SGO). The mainstay of these quality indicators include adequate radiation tumor dose and volume
Corresponding author at: 3535 Olentangy River Rd, Columbus, OH 43214, United States of America.
E-mail address: [email protected] (C. Calo).
[1–3], limitation of overall treatment time to less than approximately 56–60 days [2,4,5], the use of brachytherapy [5,6], and administration of concurrent chemotherapy [5,7]. It has been demonstrated that pa-tients treated according to specific clinical practice guidelines, regard-less of stage, have a higher cancer-specific survival after five years when compared to nonadherence to these guidelines (88% vs 56%; P b 0.001) .
In our practice, many patients undergo external beam radiation (EBRT) and brachytherapy (BT) at different locations. Our objective was to compare rates of completion of radiation within 60 days (the suggested metric of the Commission on Cancer, ) among patients re-ceiving treatment at one institution to those receiving treatment at mul-tiple institutions. Secondary outcomes included compliance with
sensitizing chemotherapy, completion of brachytherapy, total radiation dose, recurrence rate, and overall survival.
2. Materials and methods
A retrospective chart review was performed that included patients diagnosed with cervical cancer between January of 2000 to December of 2016 who were planned to undergo primary treatment with sensitiz-ing chemotherapy, EBRT and BT at the primary institution (PI). Patients with locally advanced stage IB1-IVA cervical cancer who had established care with a gynecologic oncologist at the PI were included in this study. While the patients were seen at the PI they were often given the choice of several locations to undergo their radiation therapy and several pa-tients opted to receive a portion of their RT at an outlying facility (OLF).
Eligible patients were identified by using the Oncology Registry Da-tabase. This database identifies reportable cancers using both national and state standards. Patients with cervical cancer were identified by using ICD-10 codes as well as pathology reports. Each case was then in-dividually reviewed by certified tumor registrars to determine if these were new diagnoses. Patients who met criteria were then added to the database and followed for the duration of their life. Follow-up infor-mation was obtained from medical record review, coordination with the Columbus oncology associates database, and letters sent to primary physicians when necessary. Information regarding death was obtained from review of monthly death certificates for the state of Ohio. If infor-mation was not available, local obituary searches were performed as needed.
For patients who met inclusion criteria, a thorough chart review of histology, imaging, clinic notes, chemotherapy summaries, and radia-tion therapy summaries was performed. The distance to treatment facil-ity was calculated using Google maps  with the patient's home address listed on their clinic chart at initial visit and the respective treat-ment facility. The distance in miles was recorded for the route with the shortest duration, regardless of the mileage.