Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline.

Purpose: To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer.
Methods: ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines.
Results: Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater.
Recommendations: Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
Competing Interests: Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article. The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or jco.ascopubs.org/site/ifc. Linus T. ChuangNo relationship to discloseSarah TeminNo relationship to discloseRolando CamachoNo relationship to discloseAlfonso Dueñas-GonzalezNo relationship to discloseSarah FeldmanNo relationship to discloseMurat GultekinNo relationship to discloseVandana GuptaNo relationship to discloseSusan HortonNo relationship to discloseGraciela JacobNo relationship to discloseElizabeth A. KiddResearch Funding: SiemensKennedy LishimpiNo relationship to discloseCarolyn NakisigeNo relationship to discloseJoo-Hyun NamResearch Funding: AstraZeneca, AbbVieHextan Yuen Sheung NganHonoraria: Merck Sharp & Dohme (Asia), Amgen (Asia), Ipsos Healthcare, Chindex Hong Kong, Pfizer Consulting or Advisory Role: Amgen (Asia) Speakers’ Bureau: Merck Sharp & Dohme (Asia), Chindex Hong Kong, Pfizer Research Funding: Amgen (Asia; Inst) Travel, Accommodations, Expenses: Roche Hong Kong, Chindex Hong Kong, Merck Sharp & Dohme (Asia), Pfizer, AstraZenecaWilliam SmallHonoraria: Carl Zeiss Meditec Speakers’ Bureau: Carl Zeiss Meditec Research Funding: Carl Zeiss Meditec Travel, Accommodations, Expenses: Carl Zeiss MeditecGillian ThomasNo relationship to discloseJonathan S. BerekConsulting or Advisory Role: Atara Biotherapeutics Research Funding: Tesaro (Inst), AstraZeneca (Inst)