ASCO Resource-Stratified Clinical Practice Guideline Addresses Care for Women With Invasive Cervical Cancer

ASCO Resource-Stratified Clinical Practice Guideline Addresses Care for Women With Invasive Cervical Cancer

Cervical cancer affects women worldwide, but resource disparities mean that treatments differ based on the geographic location of patients—which explains the high rate of deaths from cervical cancer in areas where screening, prevention, and treatment efforts are not easily accessible.

Dr. Linus T. Chuang
Dr. Jonathan S. Berek
An ASCO guideline submitted this March to Journal of Global Oncology—“Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline”—gives recommendations based on four tiers of resources available in countries around the world, classified as basic, limited, enhanced, and maximal settings.

This guideline helps answer the question: “What can we recommend to countries that do not have the resources that we are so richly blessed with in most areas of the United States?” said Jonathan S. Berek, MD, MMS, FASCO, of Stanford University School of Medicine and co-chair of the Cervical Cancer Treatment (Resource Stratified) panel, which facilitated the guideline.

Dr. Berek co-chaired the guideline panel with Linus T. Chuang, MD, of the Icahn School of Medicine at Mount Sinai. The recommendations “are the first of their kind for ASCO—resource-stratified mainly for the best evidence of how to treat patients with cervical cancer, both in high-resource parts of our country and others, and for regions with lower resources such as some sub-Saharan African countries,” Dr. Chuang said.

Cervical cancer kills approximately 4,000 women in the United States each year1 and a quarter of a million women around the world, with more than 500,000 new cases each year worldwide.2 Approximately 85% of cervical cancers occur in low- and middle-income countries.

“The death rate is appalling,” Dr. Berek said. “It is particularly a problem in sub-Saharan Africa and Asia because of a lack of early detection and screening. In many countries, when a woman is diagnosed with cervical cancer, it is a death sentence.”

The guideline was written with a panel of international experts, including those in medical oncology, gynecologic oncology, radiation oncology, palliative care, health economics, obstetrics and gynecology, and the patient advocacy community. Experts hailed from the United States, Spain, Mexico, Turkey, Canada, Argentina, Zambia, Uganda, South Korea, China, and India.

The panel evaluated existing literature and similar guidelines, and reviewed cost-effective analyses to determine how best to develop the guidelines for each tier. The recommendations note that they are intended to “complement, but not replace, local guidelines.”

Recommendations

In each tier, and for each stage of cervical cancer, the recommendations discuss the optimal therapy, which can include a mix of radiation, chemotherapy, and/or surgery, when appropriate, given the clinical setting and the patient’s particular situation, as well as palliative care and pain management.

It is hoped that the guideline will be used as a tool for clinicians to take to policymakers in their regions to show what is possible with the right resources for women who are diagnosed with cervical cancer—often young women in their most productive years.

“The hope is that because of this effort from ASCO, the guideline will provide support and perhaps even political clout to colleagues around the world who are trying to do their best to save the lives of women who might not otherwise be saved,” Dr. Berek said. Many countries in the basic tier are facing priority problems, such as infectious disease or deaths from malnutrition and unclean water. “They are dealing with issues so fundamental to society, that when you talk about cancer, it’s almost not important to them,” he said. Nonetheless, preventing and treating this disease can potentially have a large impact on societies.

“For policymakers, the guideline is a way to let governments take notice of what needs to be done and what they should be aiming for, for patients with cervical cancer,” Dr. Chuang said.

Additional Guidelines in Development

ASCO is also working on two additional resource-stratified guidelines to further address cervical cancer. One will address the importance of cervical cancer screening and treating precursor lesions, and the other will focus on the prevention of HPV infection—which can lead to the development of cervical cancer—with the use of an HPV vaccine. Both guidelines are in development and are expected to be published later in 2016.  

– Cheryl Alkon