Treatment (Tx) patterns and decision drivers in Chinese patients (pts) with locally advanced cervical cancer (LACC): Results from a national physician survey.

Abstract

e17501 Background: Cervical cancer (CC) is the fourth most common and lethal cancer in women, with ~23% in Chinese pts. We sought to characterize real-world Tx patterns and decision drivers in LACC in China. Methods: A cross-sectional, 3-phase survey (quantitative development, cognitive, and quantitative interviews) of 360 physicians across 21 cities in China. Primary outcomes included Tx patterns and decision drivers for Chinese pts with LACC. Cancer stage was reported per International Federation of Gynecology and Obstetrics (FIGO) 2018. Results: Respondents were gynecologists/gynecologic oncologists (200; 55.6%), radiation oncologists (130; 36.1%), and medical oncologists (30; 8.3%), and reported a high proportion of pts with stages IB3–IVA CC (67.7%), with 16.5%, 14.5%, 13.3%, 10.2%, 7.0%, and 6.0% having stage IB3–IIA2, IIB, IIIA–IIIB, IIIC (T1–T2b), IIIC (T3a + T3b), and IVA CC, respectively. Guidelines typically define stages IB3–IVA as LACC; however, a range of stages were considered LACC, with only 28.3% and 3.1% of respondents saying they would define LACC as stages IB3–IVA and IB3 + IIA2–IVA, respectively. Guidelines recommend concurrent chemoradiotherapy (CCRT) for LACC, comprising external beam radiotherapy (EBRT) with concurrent cisplatin followed by brachytherapy (BT); however, CCRT alone was used by 18.1%, 42.2%, and 52.1% of respondents in pts with stage IB3–IIA2, IIB, and III–IVA CC, respectively, with surgery-based Tx used by 67.1%, 42.0%, and 26.6% in pts with these stages, respectively. Surgery + chemoradiotherapy (neoadjuvant and/or adjuvant) was the most common surgery-based Tx, used by 24.7%, 16.2%, and 10.3% in pts with stage IB3–IIA2, IIB, and III–IVA CC, respectively. Platinum monotherapy was used in CCRT by 31.6%, with more preferring platinum + taxane (49.6%). In stages IB3–IVA CC, radiotherapy (RT) types consisted of 57.7% EBRT plus BT, with EBRT alone and BT alone used by 22.3% and 10.8%, respectively. The most important LACC Tx decision drivers were efficacy (91.7%), CC stage (89.7%) and safety (88.6%). High proportions reported Tx guidelines (80.3–84.7%) as decision drivers; moreover, 76.4% said clinical experience (personal/multidisciplinary team) was a driver. Tx accessibility (83.6%), and Tx Cost (76.9%) were also important factors, as was pt preference (64.2%). Access to RT was an important challenge, with only 63.9% reporting that both EBRT and BT could be performed at their hospitals. RT-related issues (e.g. lack of equipment) were reported as an unmet medical need by 66.4%. Mean waiting time for RT was reported as 10.6 days. Conclusions: These descriptive survey data show relatively low adherence of real-world Chinese LACC Tx practices to guideline recommendations, highlighting unmet needs to enable adoption of CCRT as standard of care, the need for new Tx, and the importance of Tx standardization.