2885 - Analysis of Disparities in Prolonged Radiation Course in Definitive Cervical Cancer Treatment
Presenter(s)
S. X. Yan1, M. M. Qureshi1, K. Eurich2, and S. Mellinghoff3; 1Department of Radiation Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 2Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 3Boston University School of Medicine (BUSM), Boston, MA, United States
Purpose/Objective(s): A prolonged treatment course is associated with lower survival in patients receiving definitive radiation for cervical carcinoma. This study investigated factors associated with longer radiation elapsed days in a large patient database.
Materials/Methods: Patients with FIGO stage IB to IVA cervical carcinoma who received definitive radiation were identified from the National Cancer Database from 2004 to 2022. The primary outcome was radiation elapsed time. A negative binomial regression model was used to evaluate the association of the following factors with radiation elapsed time: age, race, Hispanic ethnicity, insurance status, income, year of diagnosis, Charlson-Deyo comorbidity score (CDS), FIGO stage, treatment (radiation, chemoradiation), facility type, location (Northeast, South, Midwest, West), and rurality (metro, urban, rural). Crude and adjusted incidence rate ratios (IRR) with 95% confidence intervals (CIs) were computed. The multivariable (MV) model adjusted for factors significant in univariable analysis.
Results: A total of 34,049 cervical cancer patients were identified. Median time to complete treatment was 54 days [interquartile range IQR, 46-64 days]. The study cohort was primarily white (75.1%), non-Hispanic (85.3%), with no comorbidity (84.1%) and held private insurance (38.8%) or Medicare (24.0%). The majority of patients received chemoradiation (90.3%) and were treated in metro or urban settings (98.0%). On MV analysis, age, race, insurance, income, year of diagnosis, FIGO stage, location and time to treatment remained significant predictors of radiation elapsed time. Increasing income and treatment in recent years were associated with shorter radiation elapsed time. Medicaid/Uninsured (IRR 1.04 vs. private insurance) and stage III (IRR 1.06 vs. IB) patients experienced increased radiation elapsed days. Compared to whites, Blacks had similar radiation elapsed time (IRR 1.01), with “other” race reporting shorter treatment duration (IRR 0.98). Hispanic ethnicity, CDS, treatment, facility type, and rurality were not associated with longer elapsed treatment time.
Conclusion: Several socioeconomic factors were associated with a longer time to complete treatment. Further study is warranted to elucidate the impact of disparities in treatment on outcome.