Treatment delay and prolongation in locally advanced cervical cancer

Prolonged chemoradiation (CRT) duration predicts inferior survival in locally advanced cervical cancer (LACC). Pre-treatment delays and causes of prolonged treatment duration are less characterized. We aimed to quantify delays across the care continuum and identify predictors of delayed CRT initiation and treatment prolongation.

In this retrospective cohort study, we evaluated LACC patients receiving definitive CRT from 2013 to 2024 at an NCI-designated Cancer Center. We assessed care intervals and sociodemographic/clinical variables. Primary outcome was total patient delay (diagnosis to CRT completion), subdivided into delayed treatment initiation (>75th percentile from diagnosis to CRT) and prolonged CRT duration (>56 days). Secondary outcomes included predictors of delay / prolongation (x ² tests, logistic regression), progression free survival (PFS), and overall survival (OS).

Among 92 patients, median time to CRT initiation was 49 days (IQR 40-62) and median treatment duration was 57 days (IQR 52-60). Treatment delay or prolongation was associated with insurance type, external beam radiation therapy (EBRT) at an outside facility, and adenocarcinoma histology (p < 0.05). Time from diagnosis to completion of LACC staging was the interval most predictive of treatment delay (OR 3.7, CI 1.8-7.7). Treatment prolongation was associated with longer intervals between EBRT and brachytherapy (BT) (OR 2.6,CI 1.6-4.2) but not with time to initiate EBRT or EBRT duration. PFS and OS were not associated with primary outcomes.

A quarter of patients waited over 2 months to initiate CRT, and half experienced prolonged treatment duration. Delays in staging and transitions in care, especially between institutions, contributed significantly to total patient delay.