2782 - Patterns of Recurrence and Outcomes in Differentiated Thyroid Carcinoma Patients Treated with External Beam Radiotherapy
Presenter(s)
E. J. G. Feliciano1, A. E. Go2, J. Martinez1, F. D. V. Ho3, J. F. Wu4, J. Willmann5,6, K. Lapen6, H. C. Hugo1, Y. Jeong1, A. Singh7, A. Busmail1, N. Shah1, J. Chen6, M. Cabaero8, F. Y. Y. Moraes9, P. Iyengar10, N. Y. Lee10, V. L. Mango6, T. P. Kingham11, and E. C. Dee10; 1NYC Health + Hospitals/Elmhurst, Queens, NY, 2Cebu Institute of Medicine, Cebu City, Philippines, 3University of the Philippines, Manila, Philippines, 4Medical College of Wisconsin, Milwaukee, WI, 5Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland, 6Memorial Sloan Kettering Cancer Center, New York, NY, 7NYC Health + Hospitals/Elmhurst, Quees, NY, 8Cornell University, Ithaca, NY, 9Queen's University Global Oncology Program, Kingston, ON, Canada, 10Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 11Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
Purpose/Objective(s): Global cervical cancer incidence and mortality represent significant inequities; majority of cases and deaths occur in low-resource settings. Despite being largely preventable, many women around the world face inadequate healthcare infrastructure, lack of awareness, cultural stigma, and gendered barriers to seeking care. Therefore, we investigated associations between cervical cancer outcomes and health system metrics to help inform global cancer policy.
Materials/Methods: Estimates of age-standardized mortality-to-incidence ratios (MIR) were derived from GLOBOCAN 2022 for female patients with cervical cancer of all ages. We collected the following variables for each country, as available: gender inequality index (GII; a combined metric of health, empowerment, and economic agency), radiotherapy centers/1000population, out-of-pocket expenditure as percentage of current health expenditure, health spending (% gross domestic product [GDP]), physicians/1000population, nurses and midwives/1000population, surgical workforce/1000population, GDP per capita, universal Health Coverage Service Coverage Index (UHC index), availability of pathology services, and human development index (HDI).
We evaluated the association between each variable and MIR using univariable linear regressions. Metrics with P<0.0045 (Bonferroni corrected) were included in multivariable models. Variation inflation factor (VIF>10 excluded) analysis informed exclusion of variables with significant multicollinearity. R2 defined goodness of fit.Results: On univariable analysis, all metrics including radiotherapy centers/1000population were significantly associated with MIR of cancer (<0.001 for all). After including metrics that were significant on univariable analysis, HDI demonstrated significant collinearity and was excluded from the multivariable model. Therefore, the final multivariable model with 10 variables had R2 of 0.81.
On multivariable analysis, the following variables were independently associated with lower (improved) MIR for cancer: 1) nurses/midwives per 1000 population (ß=–0.0071, p=0.029) and 2) UHC index (ß=–0.0023, P=0.013). In addition, greater gender inequality (greater GII) was associated with greater (worse) MIR (ß=0.30, P=0.002).Conclusion: Our global analysis of health system metrics suggest improved access to radiotherapy and increased healthcare resource allocation were associated with improved cervical cancer MIR on univariable analysis. Additionally, the multivariable model with strong explanatory power (R2=0.81) suggests that promoting progress towards UHC and strengthening the nursing/midwifery workforce may be independently associated with improved cervical cancer MIR. Importantly, greater gender inequality was associated with worse MIR. These findings may inform efforts to improve global cervical cancer care and underscore the importance of gender equity in improving global cancer outcomes.