1
|
Dinicu AI, Dioun S, Wang Y, Huang Y, Wright JD, Tergas AI. Survival rates in Hispanic/Latinx subpopulations with cervical cancer associated with disparities in guideline-concordant care. Gynecol Oncol 2024; 184:214-223. [PMID: 38340647 DOI: 10.1016/j.ygyno.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Failure to deliver guideline-concordant treatment may contribute to disparities among Hispanic/Latinx cervical cancer patients. This study investigated the association between survival rates in Hispanic/Latinx subpopulations and the provision of guideline-concordant care. METHODS We analyzed patients with primary cervical cancer from 2004 to 2019 (National Cancer Database). We developed nine quality metrics based on FIGO staging (2009). Clinical and demographic covariates were analyzed using Chi-squared tests. Adjusted associations between receipt of guideline-concordant care and races and ethnicities were analyzed using multivariable marginal Poisson regression models. Adjusted Cox proportional hazard models were utilized to evaluate survival probability. RESULTS A total of 95,589 patients were included. Hispanic/Latinx and Non-Hispanic Black (NHB) populations were less likely to receive guideline-concordant care in four and five out of nine quality metrics, respectively. Nonetheless, the Hispanic/Latinx group exhibited better survival outcomes in seven of nine quality metrics. Compared to Mexican patients, Cuban patients were 1.17 times as likely to receive timely initiation of treatment in early-stage disease (RR 1.17, 95% CI 1.04-1.37, p < 0.001). Puerto Rican and Dominican patients were, respectively, 1.16 (RR 1.16, 95% CI 1.07-1.27, p < 0.001) and 1.19 (RR 1.19, 95% 1.04-1.37, p > 0.01) times as likely to undergo timely initiation of treatment in early-stage disease. Patients of South or Central American (RR 1.18, 95% CI 1.10-1.27, p < 0.001) origin were more likely to undergo timely initiation of treatment in locally advanced disease. CONCLUSION Significant differences in survival were identified among our cohort despite the receipt of guideline concordant care, with notably higher survival among Hispanic/Latinx populations.
Collapse
Affiliation(s)
- Andreea I Dinicu
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, USA
| | - Shayan Dioun
- Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Yongzhe Wang
- Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, USA
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Ana I Tergas
- Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, USA; Division of Health Equity, Department of Population Science, Beckman Research Institute, City of Hope Comprehensive Cancer Center, USA.
| |
Collapse
|
2
|
Shan Y, Ding Z, Chen A, Cui Z. Incidence, prognostic factors, and a nomogram of cervical cancer with lung metastasis: A SEER-based study. J Gynecol Obstet Hum Reprod 2024; 53:102757. [PMID: 38403266 DOI: 10.1016/j.jogoh.2024.102757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 02/27/2024]
Abstract
AIMS The purpose of this study was to investigate the incidence, survival and prognostic factors of cervical cancer with lung metastasis at the initial diagnosis and to develop a visual nomogram to predict the prognosis of these patients. METHODS We used the Surveillance, Epidemiology and End Results (SEER) database to screen patients diagnosed with cervical cancer from 2010 to 2015. After strict inclusion and exclusion, the chi-square test was used to evaluate the differences in the clinical characteristics of patients with cervical cancer, and then we used Kaplan-Meier method to perform survival analysis among cervical cancer patients with lung metastasis. Next, univariate and multivariate Cox proportional hazard regression models were used to estimate prognostic factors of these patients and we developed a visualized and novel nomogram to judge the prognosis. RESULTS 476 patients with lung metastasis and 12,016 patients without lung metastasis were included in this study. The incidence of lung metastasis was higher in unmarried white cervical cancer patients between the ages of 40 and 60, and grade III cervical squamous cell carcinoma patients were more likely to have lung metastasis. In addition, grade, surgery, radiotherapy, sequence of surgery and radiotherapy and chemotherapy were significantly related to the outcomes of cervical cancer patients with lung metastasis. Furthermore, our nomogram could predict the 3-year and 5-year overall survival (OS) of these patients. Finally, the AUC of 3-year OS and 5-year OS were confirmed to be 0.969 and 0.939 respectively by ROC curves, with good consistency. CONCLUSIONS Age at diagnosis, race, marital status, and characteristics of the tumor can influence the incidence of lung metastasis in cervical cancer patients. Besides, grade, surgery, radiotherapy, sequence of surgery and radiotherapy and chemotherapy may deeply affect the prognosis of cervical cancer patients with lung metastasis. The nomogram built in this study may help clinicians to formulate individualized treatment strategies and encourage the development of more and more comprehensive and accurate predictive models.
Collapse
Affiliation(s)
- Yuping Shan
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, NO.16 Jiangsu Road, Qingdao 266000, China
| | - Zhaoxia Ding
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, NO.16 Jiangsu Road, Qingdao 266000, China
| | - Aiping Chen
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, NO.16 Jiangsu Road, Qingdao 266000, China.
| | - Zicheng Cui
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, NO.16 Jiangsu Road, Qingdao 266000, China
| |
Collapse
|
3
|
Tjioe KC, Miranda-Galvis M, Johnson MS, Agrawal G, Balas EA, Cortes JE. The interaction between social determinants of health and cervical cancer survival: A systematic review. Gynecol Oncol 2024; 181:141-154. [PMID: 38163384 DOI: 10.1016/j.ygyno.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This systematic review aimed to investigate what are the most relevant social determinants of health (SDH), how they are measured, how they interact among themselves and what is their impact on the outcomes of cervical cancer patients. METHODS Search was performed in PubMed, Scopus, Web of Science, Embase, Cochrane, and Google Scholar databases from January 2001 to September 2022. The protocol was registered at PROSPERO (CRD42022346854). We followed the PICOS strategy: Population- Patients treated for cervical cancer in the United States; Intervention - Any SDH; Comparison- None; Outcome measures- Cancer treatment outcomes related to the survival of the patients; Types of studies- Observational studies. Two reviewers extracted the data following the PRISMA guidelines. Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for risk of bias (ROB) assessment. RESULTS Twenty-four studies were included (22 had low and 2 had moderate ROB). Most manuscripts analyzed data from public registries (83.3%) and only one SDH (54.17%). The SDH category of Neighborhood was not included in any study. Although the SDH were measured differently across the studies, not being married, receiving treatment at a low-volume hospital, and having public insurance (Medicaid or Medicare) or not being insured was associated with shorter survival of cervical cancer patients in most studies. CONCLUSIONS There is a deficit in the number of studies comprehensively assessing the impact of SDH on cervical cancer treatment-related outcomes. Marital status, hospital volume and health insurance status are potential predictors of worse outcome.
Collapse
Affiliation(s)
- Kellen Cristine Tjioe
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Marian Symmes Johnson
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gagan Agrawal
- School of Computing, University of Georgia, Athens, GA, USA
| | - E Andrew Balas
- Department of Interdisciplinary Health Sciences, Augusta University, Augusta, GA, USA
| | - Jorge E Cortes
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| |
Collapse
|
4
|
Shan Y, Ding Z, Cui Z, Chen A. Incidence, prognostic factors and a nomogram of cervical cancer with distant organ metastasis: a SEER-based study. J OBSTET GYNAECOL 2023; 43:2181690. [PMID: 36927263 DOI: 10.1080/01443615.2023.2181690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study was to investigate the incidence, survival and prognostic factors of cervical cancer with distant organ metastasis, and to develop a nomogram to predict the prognosis of cervical cancer. We used the Surveillance, Epidemiology and End Results (SEER) database to screen patients diagnosed with cervical cancer from 2010 to 2014. The chi-squared test was used to analyse the differences in clinical characteristics, and we used Kaplan-Meier methods to perform survival analysis. Univariate and multivariate Cox proportional hazard regression models were used to estimate prognostic factors, and we developed a visual nomogram to judge the prognosis. We found that lung metastasis was the most common in cervical cancer patients with distant organ metastasis. Age, race, characteristics of the tumour, and therapy should be considered when analysing the prognosis of cervical cancer patients. The findings of this study may help clinicians to formulate individualised treatment strategies.Impact StatementWhat is already known on this subject? Distant organ metastasis of cervical cancer mainly involves lung, bone, liver and brain. Once it occurs, the survival and prognosis will be threatened seriously.What the results of this study add? 4176 patients were included, and lung metastasis was the most common in cervical cancer with distant organ metastasis (3.5%). Additionally, age, race, tumour grade, histological type, T-stage, N-stage, lung, liver and bone metastasis and the treatment mode are significantly related to the outcomes of cervical cancer patients. Furthermore, we developed a nomogram that could predict the probability of three-year and five-year OS.What the implications are of these findings for clinical practice and/or further research? The findings of this study may drive more and more studies focussing on the comprehensive prognostic assessment, diagnosis, and treatment of distant metastasis of cervical cancer. Besides, clinicians can utilise these findings to formulate individualised treatment strategies.
Collapse
Affiliation(s)
- Yuping Shan
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaoxia Ding
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zicheng Cui
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aiping Chen
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
5
|
Wang X, Lu X, Chen J, Yi H, Lan Q. Survival benefit of surgery with postoperative radiotherapy in locally advanced cervical adenocarcinoma: a population-based analysis. BMC Surg 2023; 23:299. [PMID: 37789291 PMCID: PMC10548725 DOI: 10.1186/s12893-023-02203-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The incidence of cervical adenocarcinoma (AC) has experienced a considerable increase in recent decades. Despite this, our understanding of the optimal management of locally advanced cervical AC remains limited. The present study sought to compare the clinical outcomes of radical hysterectomy with postoperative radiotherapy (PORT) and primary radiotherapy (RT) in patients with locally advanced cervical AC using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS The data were extracted from the SEER database utilizing the SEER ∗ STAT software (version 8.4.0.1). The study included patients diagnosed with locally advanced cervical AC between 2004 and 2017 with adequate information available for analysis. Patients were assigned to either the Surgery + PORT or Primary RT group based on treatment modality, and their clinical characteristics were compared. Propensity score matching (PSM) was utilized to adjust for differences in baseline characteristics between groups. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). RESULTS Of the 1363 patients who met the inclusion criteria, 302 (22.16%) underwent Surgery + PORT, while 1061 patients received Primary RT. The two groups differed significantly in terms of age, year of diagnosis, tumor size, grade, stage, T/N stage, and chemotherapy. PSM was performed to balance the baseline characteristics between the two groups, resulting in 594 patients being analyzed. After PSM, the Surgery + PORT group exhibited significantly improved survival rates. The 5-year OS rates were 69.7% (95% CI: 63.3%-76.9%) for the Surgery + PORT group and 60.9% (95% CI: 56.0%-66.3%) for the group receiving Primary RT (p = 0.002). The 5-year CSS rates for the two groups were 70.7% (95% CI: 64.3%-77.8%) and 66.2% (95% CI: 61.3%-71.5%), respectively (p = 0.049). Multivariate analysis revealed that Surgery + PORT was an independent favorable prognostic factor for OS (HR = 0.60, p = 0.001) and CSS (HR = 0.69, p = 0.022). Although the combined approach of surgery and PORT resulted in a favorable impact on OS in patients aged 65 years or older (HR = 0.57, p = 0.048), it did not result in a statistically significant improvement in CSS in the same age group (HR = 0.56, p = 0.087). Similarly, the combined treatment did not yield a statistically significant increase in either OS (HR = 0.78, p = 0.344) or CSS (HR = 0.89, p = 0.668) in patients with tumors larger than 60 mm. CONCLUSION The present study demonstrated that Surgery + PORT was associated with improved OS and CSS in patients with locally advanced cervical AC when compared to Primary RT. As such, Surgery + PORT may be a preferable therapeutic option for carefully selected patients with cervical AC. These findings offer valuable insight into the management of locally advanced cervical AC and may assist in personalized treatment decisions.
Collapse
Affiliation(s)
- Xia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang University, No.1 Minde Street, Nanchang, 330000, Jiangxi Province, People's Republic of China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi Province, China
- Radiation-Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiaojuan Lu
- Department of Obstetrics and Gynecology, De'an County People's Hospital, Jiujiang, Jiangxi Province, China
| | - Junxing Chen
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang University, No.1 Minde Street, Nanchang, 330000, Jiangxi Province, People's Republic of China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi Province, China
- Radiation-Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hanjie Yi
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang University, No.1 Minde Street, Nanchang, 330000, Jiangxi Province, People's Republic of China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi Province, China
- Radiation-Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi Province, China
| | - Qiongyu Lan
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang University, No.1 Minde Street, Nanchang, 330000, Jiangxi Province, People's Republic of China.
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi Province, China.
- Radiation-Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi Province, China.
| |
Collapse
|
6
|
Hong JH, Swami N, Dee EC, Gomez SL, Lam MB. Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women. J Surg Oncol 2023; 127:882-890. [PMID: 36719164 DOI: 10.1002/jso.27204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). METHODS Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. RESULTS AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. CONCLUSIONS Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.
Collapse
Affiliation(s)
- Ji Hyun Hong
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nishwant Swami
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Jeudin PP, Sanchez-Covarrubias AP, Thiele AR, Reis IM, Kobetz E, George SHL, Schlumbrecht MP. Differences in Cervical Cancer Outcomes by Caribbean Nativity in Black and White Women in Florida. Cancer Control 2023; 30:10732748231176642. [PMID: 37226430 PMCID: PMC10226035 DOI: 10.1177/10732748231176642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Racial disparities among women with cervical cancer have been reported but are understudied in Caribbean immigrants. The objective of this study is to describe the disparities in clinical presentation and outcomes between Caribbean-born (CB) and US-born (USB) women with cervical cancer by race and nativity. METHODS An analysis of the Florida Cancer Data Service (FCDS), the statewide cancer registry, was performed to identify women diagnosed with invasive cervical cancer between 1981 and 2016. Women were classified as USB White or Black and CB White or Black. Clinical data were abstracted. Analyses were done using chi square, ANOVA, Kaplan-Meier and Cox proportional hazards models, with significance set at P < .05. RESULTS 14 932 women were included in the analysis. USB Black women had the lowest mean age at diagnosis, while CB Black women were diagnosed at later stages of disease. USB White women and CB White women had better OS (median OS 70.4 and 71.5 months, respectively) than USB Black and CB Black women (median OS 42.4 and 63.8 months, respectively) (P < .0001). In multivariable analysis, relative to USB Black women, CB Blacks (HR .67, CI .54-.83), and CB White (HR .66, CI .55-.79) had better odds of OS. White race among USB women was not significantly associated with improved survival (P = .087). CONCLUSION Race alone is not a determinant of cancer mortality in women with cervical cancer. Understanding the impact of nativity on cancer outcomes is crucial to improve health outcomes.
Collapse
Affiliation(s)
- Patricia P. Jeudin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Alex P. Sanchez-Covarrubias
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Isildinha M. Reis
- Department of Public Health Services, Division of Biostatistics, University of Miami, Miami, FL, USA
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sophia H. L. George
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Matthew P. Schlumbrecht
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| |
Collapse
|
8
|
Feldman S, Lykken JM, Haas JS, Werner CL, Kobrin SC, Tiro JA, Chubak J, Kamineni A. Factors associated with timely colposcopy following an abnormal cervical cancer test result. Prev Med 2022; 164:107307. [PMID: 36270434 PMCID: PMC9808794 DOI: 10.1016/j.ypmed.2022.107307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 01/05/2023]
Abstract
Successful cervical cancer prevention requires screening and appropriate management of abnormal test results. Management includes diagnostic evaluation and treatment, if indicated, based on cervical cancer risk after most abnormal test results. There is little guidance on the optimal timing of diagnostic evaluation, and few data exist on factors associated with timely management. We quantified time-to-colposcopy within 12 months of an abnormal cervical cancer screening or surveillance test result from 2010 to 2018 across three diverse healthcare systems and described factors associated with timely colposcopy. Among 21-65 year-old patients with an abnormal test result for which colposcopy was indicated (n = 28,706), we calculated the proportion who received a colposcopy within 12 months of the abnormal test and used Kaplan-Meier methods to estimate the probability of colposcopy within 12 months. Across all systems, 75.3% of patients received a colposcopy within 12 months, with site-specific estimates ranging from 70.0 to 83.0%. We fit mixed-effects multivariable logistic regression models to identify factors associated with receipt of colposcopy within 12 months. The healthcare system and cytology result severity were the most important factors associated with of timely colposcopy. We observed that sites with more centralized processes had higher proportions of colposcopy completion, and patients with high-grade results were more consistently evaluated earlier than patients with low-grade results. Patient age also affected receipt of timely colposcopy, though this association differed by healthcare system and result severity. These data suggest opportunities for system-level interventions to improve management of abnormal cervical cancer test results.
Collapse
Affiliation(s)
- Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Jacquelyn M Lykken
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Claudia L Werner
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Parkland Health, Dallas, TX, United States of America
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Jasmin A Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| |
Collapse
|
9
|
Alimena S, Davis M, Pelletier A, Terry K, King M, Feldman S. Regional Variation in Access to Oncologic Care and Racial Disparities Among Cervical Cancer Patients. Am J Clin Oncol 2022; 45:415-421. [PMID: 36111738 DOI: 10.1097/coc.0000000000000944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The goal of this study was to determine whether access to gynecologic oncologists is correlated with disparate outcomes among cervical cancer patients, especially among Black women. MATERIALS AND METHODS An ecological study was performed using the National Cancer Database among stage I-IVA cervical cancer patients from 2004 to 2014. Data from the National Cancer Institute, the Society of Gynecologic Oncology, and the United States Census were compiled to describe access to care by region. Factors associated with receipt of optimal treatment (defined as surgery and/or radiation for stage IA-IB1 and IIA1; radiation and chemotherapy for stage IB2, IIA2, IIB-IVA or node positive disease) were identified using multivariate logistic regressions stratified by region, controlling for confounding factors including the number of gynecologic oncologists per states in each subregion. Cox multivariate survival analyses stratified by region were also performed. RESULTS Of 42,213 women, 17.0% were Black. On multivariate analysis controlling for confounders, all Southern women were less likely to receive optimal treatment (adjusted odds ratio [aOR]: 0.80, 95% confidence interval [95% CI]: 0.75-0.85, P <0.001) compared with Northeastern women. Black women in the South (aOR: 0.76, 95% CI: 0.70-0.83, P <0.001) and Midwest (aOR: 0.78, 95% CI: 0.68-0.90, P <0.001) were less likely to receive optimal treatment compared with non-Black women in those regions. Black women in the South (adjusted hazard ratio [aHR]: 1.11, 95% CI: 1.04-1.18, P <0.001) and West (aHR: 1.34, 95% CI: 1.11-1.62, P =0.002) had worse mortality compared with non-Black women in those regions, despite controlling for access to gynecologic oncologists. The South, Midwest, and West had proportionally fewer cancer centers and gynecologic oncologists compared with the Northeast. CONCLUSIONS Southern women are at risk of inadequate treatment for cervical cancer, and Black Southern women are at even higher risk of inadequate treatment and worse overall survival despite controlling for access to gynecologic oncologists. Social determinants of health and other barriers besides access to oncologists likely contribute to observed regional and racial disparities among cervical cancer patients.
Collapse
Affiliation(s)
- Stephanie Alimena
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology
| | - Michelle Davis
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology
- Division of Gynecologic Oncology, Dana Farber Cancer Institute
| | - Andrea Pelletier
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Kathryn Terry
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Martin King
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology
- Division of Gynecologic Oncology, Dana Farber Cancer Institute
| |
Collapse
|
10
|
Huepenbecker SP, Meyer LA. How Can We Pursue Equity in Cervical Cancer Prevention With Existing HPV Genotype Differences? J Natl Cancer Inst 2022; 114:787-789. [PMID: 35176166 PMCID: PMC9194615 DOI: 10.1093/jnci/djac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah P Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Larissa A Meyer
- Correspondence to: Larissa A. Meyer, MD, MPH, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas, MD Anderson Cancer Center, 1155 Herman Pressler, Unit 1362, Houston, TX 77030, USA (e-mail: )
| |
Collapse
|
11
|
Abu-Rustum NR. Reducing Disparities in Cervical Cancer Mortality Among Young Black Women. J Natl Compr Canc Netw 2021; 19:879-880. [PMID: 34340205 DOI: 10.6004/jnccn.2021.7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|