3030 - Healthcare Deserts in California: Access to Gynecological HDR

Purpose/Objective(s): California (CA) is the 3rd-largest US state and the largest by population, 60% of which lives within major urban areas. CA is below the national average with respect to new cervical cancer incidence rates and mortality rates. While cervical cancer is highly curable if caught early (>90% 5-year survival), late-stage diagnoses remain high at 50-80% which poorly impacts average survival rate. Brachytherapy is a critical component in the curative treatment of advanced gynecologic cancers, but for some patients, access to HDR is difficult due to geographic, financial, language & cultural gaps in access. CA has 73 HDR centers. The purpose of this study is to examine the geographic availability of HDR in CA and the correlation between HDR accessibility and cervical cancer mortality rates.

Materials/Methods: Publicly available health data from 2017-21 was queried from the CA Health Maps Project, CA Cancer Registry, US Census Bureau, CA Radiological Health Branch, and HDR vendors. The number of HDR centers per zip code/county were assessed. Cancer rates per county were broken down by race, socioeconomic status, incidence/mortality, rates of late-presenting cancers, % rural population, & compliance with preventative care.

Results: Counties with a higher cervical cancer mortality rate have lower compliance with regular Pap screening and preventative care. Mortality rates in Northern California are more associated with age over 65, living in rural counties, and being White/Non-Hispanic. Mortality rates in Southern California are more associated with being younger than 50, Hispanic, African American, or Asian American, and being below the poverty line. San Francisco, Los Angeles, and San Diego are the major metropolitan areas in the state and as such the majority of HDR centers are clustered in these areas (#=52, %=71). San Francisco/Northern CA have lower mortality rates than Southern CA. There is a correlation between higher geographical distance between counties with HDR centers and counties with higher mortality.

Conclusion: While there is a large concentration of HDR units in the Los Angeles/Orange area, Southern CA’s mortality rate from cervical cancer remains high. This highlights disparities in healthcare availability, where healthcare deserts are not necessarily rural but can be urban areas as well. Furthermore, the potential barriers to care vary by region and demographic. CA needs more HDR facilities as the population grows, ages, and the effects on delayed care from the COVID-19 pandemic are realized. There are opportunities for future HDR centers where late-diagnoses are high. As a large percentage of late-presenting cervical cancer diagnoses are of lower socioeconomic status, programs to support those patients’ treatments and advocacy for increased reimbursed rates in an outpatient community setting could help current facilities and help create new ones. Last, considering innovative solutions such as electronic brachytherapy or mobile HDR units could reach more patients.