Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;134(3):559-569.
doi: 10.1097/AOG.0000000000003401.

Disparities Among Cervical Cancer Patients Receiving Brachytherapy

Shaina F Bruce  1 , Tanvi V Joshi, Inna Chervoneva, Misung Yi, Sudeshna Chatterjee-Paer, Elizabeth R Burton, Mitchell I Edelson, Joel I Sorosky, Mark S Shahin
Affiliations

Disparities Among Cervical Cancer Patients Receiving Brachytherapy

Shaina F Bruce et al. Obstet Gynecol. 2019 Sep.

Abstract

Objective: To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer.

Methods: This is a retrospective cohort study of the National Cancer Database. We identified 25,223 patients diagnosed with stage IB2 through IVA cervical cancer who received radiation therapy during their primary treatment from 2004 to 2015. A univariate analysis was used to assess covariate association with brachytherapy. A multivariable regression model was used to evaluate the effect of race and insurance status on rates of brachytherapy treatment. The Cox proportional hazards model and the multiplicative hazard model were used to evaluate overall survival. P<.05 indicated a statistically significant difference for comparisons of primary and secondary outcomes.

Results: Non-Hispanic black patients received brachytherapy at a significantly lower rate than non-Hispanic white patients (odds ratio [OR] 0.93; 95% CI 0.86-0.99; P=.036); Hispanic (OR 0.93; 95% CI 0.85-1.02; P=.115) and Asian (OR 1.13; 95% CI 0.99-1.29; P=.074) patients received brachytherapy at similar rates. Compared with patients with private insurance, those who were uninsured (OR 0.72; 95% CI 0.65-0.79; P<.001), had Medicaid (OR 0.83; 95% CI 0.77-0.89; P<.001) or Medicare insurance (OR 0.85; 95% CI 0.78-0.92; P<.001) were less likely to receive brachytherapy. Brachytherapy was not found to be a mediator of race and insurance-related disparities in overall survival.

Conclusion: Racial and insurance disparities exist for those who receive brachytherapy, with many patients not receiving the standard of care, but overall survival was not affected.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Overall survival stratified by brachytherapy and categorized age. International Federation of Gynecology and Obstetrics (FIGO) IB2 (A); FIGO II (B); FIGO III (C); FIGO IVA (D).
Fig. 2.
Fig. 2.
Overall survival by race (A) and insurance group (B) with brachytherapy as strata for each International Federation of Gynecology and Obstetrics (FIGO) clinical stage.
See this image and copyright information in PMC

References

    1. Chatterjee S, Gupta D, Caputo TA, Holcomb K. Disparities in gynecological malignancies. Front Oncol 2016;6:36. - PMC - PubMed
    1. Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 2002;94:334–57. - PubMed
    1. U.S. Cancer Statistics Working Group. U.S. cancer statistics: data visualizations tool, based on November 2017 submission data (1999–2015). Available at: www.cdc.gov/cancer/dataviz. Retrieved May 1, 2019.
    1. American Cancer Society. Cancer facts and figures for African Americans 2016–2018. Atlanta (GA): American Cancer Society; 2016.
    1. Bradley CJ, Given CW, Roberts C. Health care disparities and cervical cancer. Am J Public Health 2004;94:2098–103. - PMC - PubMed

Publication types

MeSH terms