2931 - Radiotherapy Barriers and Costs for Cervical Cancer Patients in a Latin American Middle-Income Country
Presenter(s)
D. K. Dietrich1, P. N. Copeland1, I. Bobadilla2, M. P. Montenegro-Gómez2, L. Gutiérrez-Babativa2, J. K. Gómez-Muñoz2, F. J. Sabogal Camargo2, A. G. L. Vannier1, O. I. Olopade3, S. Oyola4, and A. Gonzalez2; 1University of Chicago Pritzker School of Medicine, Chicago, IL, 2Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center – CTIC, Bogotá, Colombia, 3Division of Hematology Oncology, University of Chicago Medical Center, Chicago, IL, 4Department of Family Medicine, University of Chicago Medicine, Chicago, IL
Purpose/Objective(s): Cervical cancer (CC) is the 4th leading cause of cancer morbidity and mortality in women in the world. 94% of CC deaths occur in low- to middle-income countries (LMIC). In Colombia, a LMIC, CC ranks 3rd for female cancer morbidity and mortality. RT is a mainstay treatment for the majority of CC cases. Our study is the first to—within CC patients within a LMIC in Latin America—characterize the population, identify the barriers to RT, quantify the cost of RT treatment for patients and their support networks (SN), and study HPV vaccine perspectives.
Materials/Methods: CC patients who had completed or were undergoing CC RT at one cancer center in Bogotá, Colombia completed a survey on demographics, barriers to care (e.g. living >50 miles from the cancer institution), financial and non-financial costs (i.e. opportunity costs) to patients and their SNs, and HPV vaccine knowledge. Costs were labeled as “quantifiable” costs (costs to which a specific numerical value was provided; e.g. cost of transportation to RT appointments) and “non-quantifiable” costs (costs which the patient endorsed either facing or not; e.g. patient having to change employment status due to cancer). T-tests, Fisher’s exact tests, and logistic regressions identified associations between demographics, barriers, and costs.
Results: 35 patients were recruited. 77.1% of patients were born in Colombia, 22.9% were born in Venezuela. 74.3% had subsidized insurance, 62.9% had a primary education or less, and 91.4% were diagnosed at an advanced stage. 35.3% of patients had no income prior to cancer, which increased to 65.7% at the time of survey. 36.4% of patients had a severe (>3 months) RT delay. 34.3% had never heard of the HPV vaccine. 85.7% of patients faced =1 barrier to RT; 34.3% faced =3 barriers. The most common barrier (68.6%) was living >50 miles from the cancer center. The median (IQR) cost to patients for cancer care was $538.03 (754.70) USD. 52.9% of patients became unemployed due to their cancer. Patients living >50 miles from the cancer institution were more likely on subsidized insurance (odds ratio=21.0; p=0.011). Being unemployed at the time of survey and diagnosed with advanced stage cancer were both associated with a higher number of non-quantifiable costs to the patient’s SN (p=0.022, 0.004, respectively). Citing fear of medical examination as a reason for delaying care was associated with increased quantifiable costs to the patient (p=0.043).
Conclusion: CC patients in Colombia face significant socioeconomic challenges and barriers to RT treatment. Receiving RT exacerbates these circumstances, notably impacting costs to both patients and their SNs—both in terms of finances and opportunity costs. While Colombia has universal healthcare, efforts must focus on increasing RT infrastructure across the country, decreasing cost burden, and increasing education about cancer prevention and RT. This information can guide interventions in LMICs globally.