# Surgically Treated Cervical Cancer in Manitoba: A Retrospective Study of the Impact of Geography on Care

## TL;DR

This study found no significant geographic disparity in cervical cancer outcomes for Canadian patients treated at a single center, despite differences in urban and rural residence.

## Contribution

The first Canadian study to examine the association between cervical cancer survival and distance to care.

## Key findings

- No significant difference in overall survival between urban and rural patients.
- No significant difference in recurrence-free survival after adjusting for competing risks.
- Median time to surgery was slightly longer for urban patients, but not statistically significant.

## Abstract

Despite advances in cervical cancer screening, rates of cervical cancer in Canada have risen. Traditionally, distance to care has been associated with worse disease outcomes. Yet, outcomes based on the geographic location of the patients’ residence when it comes to cervical cancer, mainly out of the United States, have revealed inconsistent patterns. In patients with primary surgically treated cervical cancer, the study aimed to investigate if a difference in overall survival or recurrence-free survival existed between individuals living within a city containing a tertiary care centre compared to those living outside city limits. Results suggested no significant geographic disparity among patients treated at one centre. Further studies are needed to strengthen this inference, given this is the first Canadian study to examine the association between survival and distance to care for cervical cancer. Additional work should also account for further demographic characteristics such as race, ethnicity, education, and socioeconomic status.

Background/Objectives: Cervical cancer outcomes based on geographic location of residence reveal inconsistent patterns, and most of the evidence is from the United States. This retrospective study aimed to investigate whether there existed a difference in overall survival (OS) and recurrence-free survival (RFS) between individuals living within a Canadian city with a tertiary care centre versus those living remotely within a large catchment area (up to >1000 km travel distance), including a sizeable rural component. Methods: Surgically treated cervical cancer patients from 2000 to 2016 were included. Patients were treated with either radical hysterectomy, trachelectomy, or simple hysterectomy. Adjuvant treatment was provided depending on surgical pathology. OS and RFS were estimated using Kaplan–Meier curves and cumulative incidence curves. Results: Two hundred and eighty-two patients with surgically treated cervical cancer were included: 185 patients living within urban city limits and 97 patients living rurally. There were no significant baseline differences between groups. No significant difference in OS or RFS was found, even after adjusting for death as a competing risk for RFS. The median time to surgery for residents living within versus outside the city was 84 vs. 66 days, respectively, although this difference was not statistically significant (p = 0.3179). Conclusions: This is the first Canadian study to examine an association between survival and distance to care for cervical cancer.