Treatment patterns and cost in advanced stage cervical cancer

From the Ramsey Group, Public Health Sciences Division

Over the years, cervical cancer screening rates have drastically increased, and the human papilloma virus vaccine is now available and accessible to millions. Although there have been preventative care advancements in cervical cancer, recurrent and/or metastatic cervical cancer (r/mCC) has remained a significant medical burden. Every year in the US, over 15% of women are diagnosed with metastatic cervical cancer and 16%-39% of women risk disease recurrence. Patients with cervical cancer disease progression have a lower 5-year-survival rate compared to patients with localized cervical cancer. Currently, the up-to-date treatments for r/mCC  are not optimal. These treatments include first-line (1L) treatment of r/mCC (chemotherapy regimens), only one second-line (2L) treatment of r/mCC (for patients whose tumors express programmed death-ligand), and beyond 2L treatments of r/mCC (which include monotherapy cytotoxic agents). Researchers are actively trying to develop novel therapies for r/mCC.  There is a lack of literature on the quality of life experienced from patients with r/mCC after progression of 1L therapy, there is also a lack of knowledge on the cost of care for r/mCC.  The treatments for r/mCC are continuing to progress and evolve, and as they evolve it’s imperative to understand the value of novel therapy for r/mCC.  The Ramsey Group, from the Public Health Sciences Division, aimed to characterize current real-world treatment patterns and total costs of care in the US among patients with r/mCC. The paper is published in Gynecologic Oncology. 

A retrospective claims analysis was conducted to identify patients diagnosed with r/mCC between January 2015 and March 2020.  Outcomes in this study included treatment patterns, duration of therapy, total costs of care in direct medical costs, and health care resource utilization (HCRU).  The costs were categorized as costs per patient per month during treatment, and cumulative costs.  Chi-squared tests and t-tests were used to test for subgroup differences in categorical and continuous variables. 

Graphical Representation of Cervical Cancer
Cervical Cancer Image from

The Ramsey Group found that treatment patterns in 2L+ were heterogenous, and a majority of r/mCC patients were treated with chemotherapy-containing regimens. However, r/mCC patients were making a shift towards immunotherapy for a longer period.  Greater than 65% of patients used first-line therapy, while one third of 2L patients used 1L treatments.  No majority treatment for 2L+ treatments was observed.  The mean total costs per patient for each month’s treatment consisted of $27,387 for 1L, $77,661 for 2L, and $53,609 for 3L. 

This is the first study to report trends in r/mCC for treatment pattens and all-cause costs in the US.  The Ramsey group elaborated on r/mCC by saying, “R/mCC presents a substantial economic burden to the health care system. Although immunotherapy is increasingly used to treat r/mCC, the finding that only a small subset of patients stayed on immunotherapy for a longer period, along with the marked heterogeneity in treatment patterns, suggests an unmet need for more therapeutic options for patients in the 2L+ setting.”  “Given the rapidly evolving r/mCC landscape, emerging therapies in this disease space may potentially help address these unmet needs,” they concluded.  

This research was supported by Seagan Inc.

Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Scott Ramsey was the senior author of this work.

Musa FB, Brouwer E, Ting J, Schwartz NR, Surinach A, Bloudek L, Ramsey SD. Trends in treatment patterns and costs of care among patients with advanced stage cervical cancer. Gynecologic oncology. 2022 Mar 1;164(3):645-50.