Trends in Cervical Cancer Mortality in Brazilian Women who are Screened and Not Screened

Cervical cancer in young women: Does age impact survival in cervical cancer?

BACKGROUND AND OBJECTIVES

To evaluate the oncology outcomes in cervical cancer patients aged 25 years or younger and compare them with those in older patients.

METHODS

Cervical cancer patients were retrospectively analyzed and divided into two groups: young patients (≤25 years) and older patients (>25 years). For each young patient, two controls were selected from the database of cervical cancer patients aged over 25 years, matched by FIGO stage, treatment, and histologic type.

RESULTS

A total of 138 patients were included, 46 patients aged 25 years or younger and 92 patients aged over 25 years. Of young patients, stage III was the most common, with 21 (45.5 %) patients, while stages I, II and IV occurred in 12 (26.2 %), 8 (17.4 %) and 5 (10.9 %) patients, respectively. The 5-year RFS (75 % and 73 %; P = 0.91) and 5-year OS (60 % and 67 %; P = 0.45) were not significantly different between the groups. After multivariate analysis age had no significant impact on OS (HR 1.25, 95 % CI 0.68-2.30; P = 0.46) or RFS (HR 0.95, 95 % CI 0.43-2.10; P = 0.91).

CONCLUSIONS

Cervical cancer patients aged 25 years or younger did not present a worse OS and RFS compared to patients aged over 25 years.

Real world data on cervical cancer treatment patterns, healthcare access and resource utilization in the Brazilian public healthcare system

The aim of the study is to evaluate the treatment patterns, time to start treatment, and healthcare resources utilization (HCRU) of cervical cancer (CC) patients within the Brazilian public health system (SUS). This is an observational retrospective study using SUS administrative database (DATASUS). Data from January-2014 to December-2020 was gathered from patients with the ICD-10 C53 codes. From 2014 to 2020, 206,861 women were included, among whom 90,073 (43.5%) had stage information. Of staged patients, 60.7% (54,719) had advanced disease (stages III and IV) and the most performed treatments were chemoradiotherapy (CRT) (41.6%), surgery + CRT (19.1%), radiotherapy (RT) only (16.8%) and chemotherapy (CT) only (13.3%). The proportion of patients submitted to CT in advanced stages was higher than in non-advanced stages (I and II), in contrast to RT, which was more frequent in stage I than stage IV. Median time to initiate treatment surpassed two months in approximately 30% of the cases, regardless of stage. Conization was the most performed surgical procedure. The hospitalization rate per patient per month for stage IV was twice as high as stage I (0.05 [95%CI 0.05-0.05] and 0.11 [0.11-0.11], respectively). The same trend was observed for outpatient visits (0.54 [95%CI 0.53-0.55] and 0.96 [0.93-0.98], respectively). This study demonstrated a high proportion of advanced CC at diagnosis in Brazil. The treatment pattern showed that chemoradiotherapy was the most frequent regimen overall and the use of chemotherapy and HCRU increased with staging. These results could provide information to improve public policies towards access to prevention, diagnosis, and treatment of CC in Brazil.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

OBJECTIVE

 To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not.

METHODS

 The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not.

RESULTS

 Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002).

CONCLUSION

 Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

Cervical Cancer Prevention on Instagram: Content and Social Interaction Analysis of Brazilian Accounts

OBJECTIVE

The aim of the present study was to analyse the content of posts on Instagram about cervical cancer.

METHODS

It was conducted a qualitative analysis using the 50 most popular publicly available Portuguese-language Instagram posts, containing the hashtags #cervicalcancer, #papsmear, #hpv, #papillomavirus, and #hpvvac-cine, during the Brazilian national cervical cancer prevention campaign in March 2018.

RESULTS

Posts recruited using #cervicalcancer provided 60% of posts with contents related to secondary prevention; the #papsmear provided 46% of posts with irrelevant contents; the #hpv and #papillomavirus provided 50% and 64% of posts with informative content, respectively; and the #hpvvaccine provided 58% of posts with content related to primary prevention. The posts that received the highest number of likes were those from the hashtags #hpv and #papillomavirus with 151.33 and 78.00 likes/post, respectively. The majority of posts presented less than 05 comments/post, except for the #hpv, which had 64.76 comments/post. According to the users' profiles, the majority of the posts, regardless of the hashtag used, were made by health professionals.

CONCLUSION

The focus of Instagram posts about cervical cancer is on secondary prevention, which can contribute to the promotion of health behaviours not directed to aspects of primary prevention of the disease.

Effects of bundled nursing combined with peer support on psychological state and self-efficacy of patients with cervical cancer undergoing chemotherapy

OBJECTIVE

This study analyzed the effects of bundled nursing combined with peer support on psychological state and self-efficacy of cervical cancer patients undergoing chemotherapy.

METHODS

A total of 86 patients with cervical cancer undergoing chemotherapy who were hospitalized from July 2019 to July 2020 were enrolled as study subjects. According to the method of a random number table, the selected patients were divided into a control group and an observation group and each group contained 43 patients. The control group was treated with bundled nursing care, while the observation group underwent combining treatment of both bundled nursing as well as education supported by peers. The changes of psychological state, self-efficacy and health-related quality of life of patients before and after nursing intervention were compared.

RESULTS

The scores of depression and anxiety in two groups were remarkably decreased after intervention compared with prior-treatment, and the range of decrease in the observation group was critically greater than that in control group (P<0.05). The self-efficacy scores of the two groups were substantially increased after nursing care, and the increase of the score in the observation group was critically higher than that in control group (P<0.05). In addition, the health-related quality of life scores of the two groups increased remarkably after nursing, and the extent of increase in the observation group was notably greater than that in control group (P<0.05). The degree of serum tumor markers CA125, CEA, CA199 and SCC-A in the observation group after intervention were notably lower than those in the control group (P<0.05).

CONCLUSION

The combinative practice of bundled nursing care and the supported education of peers can effectively improve the psychological status of cervical cancer patients with chemotherapy, and improve their self-efficacy and quality of life, which are all worthy of clinical promotion.