Impact of marital status on receipt of brachytherapy and survival outcomes in locally advanced cervical cancer

Minh Phuong Huynh-Le, Amy Klapheke, Rosemary D Cress, Loren K. Mell, Catheryn M. Yashar, John P. Einck, Arno J. Mundt, Jyoti S. Mayadev

Research output: Contribution to journalArticle

Abstract

Purpose: Marriage has been associated with enhanced survival among cancer patients, but conflicting correlations have been suggested in cervical cancer. We assessed the impact of marital status on receipt of brachytherapy and survival in women with locally advanced cervical cancer. Methods and Materials: Three thousand, eight hundred and twelve patients with Stage IB2–IVA cervical cancer diagnosed from 2006 to 2015 treated with external beam radiotherapy were identified from the California Cancer Registry. Chi-square tests were used to compare patient characteristics by marital status and boost type. The association of marital status with brachytherapy (BT)receipt was assessed using multiple logistic regression. Fine and Gray competing risks and Cox proportional hazards regressions were used to estimate cervical cancer–specific survival (CCSS)and overall survival (OS), respectively. Results: Most women were unmarried (58.8%). Half (50.4%)received BT, while 33.1% received no boost; most (86.3%)received chemotherapy. Unmarried women had similar odds of receiving BT as married women (OR = 1.07, 95% CI: 0.90-1.28, p = 0.4370)but were less likely to receive chemotherapy (84.3% vs. 89.1%, p < 0.0001). Singlehood was significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.03-1.42, p < 0.0174)and OS (hazard ratio = 1.18, 95% CI: 1.03-1.36, p < 0.0153). Not receiving a radiation boost was also significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.02-1.43, p = 0.0317)and OS (hazard ratio = 1.21, 95% CI: 1.05-1.40, p = 0.0100). Conclusions: There were no differences in BT receipt in married vs. unmarried patients. However, unmarried patients had worse CCSS and OS and were less likely to receive chemotherapy. Interventions targeting social factors are needed to improve outcomes in this vulnerable population.

Original languageEnglish (US)
JournalBrachytherapy
DOIs
StatePublished - Jan 1 2019

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Brachytherapy
Marital Status
Uterine Cervical Neoplasms
Survival
Drug Therapy
Vulnerable Populations
Chi-Square Distribution
Marriage
Registries
Neoplasms
Radiotherapy
Logistic Models
Radiation

Keywords

  • Brachytherapy
  • Cervical cancer
  • Marital status
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Impact of marital status on receipt of brachytherapy and survival outcomes in locally advanced cervical cancer. / Huynh-Le, Minh Phuong; Klapheke, Amy; Cress, Rosemary D; Mell, Loren K.; Yashar, Catheryn M.; Einck, John P.; Mundt, Arno J.; Mayadev, Jyoti S.

In: Brachytherapy, 01.01.2019.

Research output: Contribution to journalArticle

Huynh-Le, Minh Phuong ; Klapheke, Amy ; Cress, Rosemary D ; Mell, Loren K. ; Yashar, Catheryn M. ; Einck, John P. ; Mundt, Arno J. ; Mayadev, Jyoti S. / Impact of marital status on receipt of brachytherapy and survival outcomes in locally advanced cervical cancer. In: Brachytherapy. 2019.
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abstract = "Purpose: Marriage has been associated with enhanced survival among cancer patients, but conflicting correlations have been suggested in cervical cancer. We assessed the impact of marital status on receipt of brachytherapy and survival in women with locally advanced cervical cancer. Methods and Materials: Three thousand, eight hundred and twelve patients with Stage IB2–IVA cervical cancer diagnosed from 2006 to 2015 treated with external beam radiotherapy were identified from the California Cancer Registry. Chi-square tests were used to compare patient characteristics by marital status and boost type. The association of marital status with brachytherapy (BT)receipt was assessed using multiple logistic regression. Fine and Gray competing risks and Cox proportional hazards regressions were used to estimate cervical cancer–specific survival (CCSS)and overall survival (OS), respectively. Results: Most women were unmarried (58.8{\%}). Half (50.4{\%})received BT, while 33.1{\%} received no boost; most (86.3{\%})received chemotherapy. Unmarried women had similar odds of receiving BT as married women (OR = 1.07, 95{\%} CI: 0.90-1.28, p = 0.4370)but were less likely to receive chemotherapy (84.3{\%} vs. 89.1{\%}, p < 0.0001). Singlehood was significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95{\%} CI: 1.03-1.42, p < 0.0174)and OS (hazard ratio = 1.18, 95{\%} CI: 1.03-1.36, p < 0.0153). Not receiving a radiation boost was also significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95{\%} CI: 1.02-1.43, p = 0.0317)and OS (hazard ratio = 1.21, 95{\%} CI: 1.05-1.40, p = 0.0100). Conclusions: There were no differences in BT receipt in married vs. unmarried patients. However, unmarried patients had worse CCSS and OS and were less likely to receive chemotherapy. Interventions targeting social factors are needed to improve outcomes in this vulnerable population.",
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AU - Huynh-Le, Minh Phuong

AU - Klapheke, Amy

AU - Cress, Rosemary D

AU - Mell, Loren K.

AU - Yashar, Catheryn M.

AU - Einck, John P.

AU - Mundt, Arno J.

AU - Mayadev, Jyoti S.

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N2 - Purpose: Marriage has been associated with enhanced survival among cancer patients, but conflicting correlations have been suggested in cervical cancer. We assessed the impact of marital status on receipt of brachytherapy and survival in women with locally advanced cervical cancer. Methods and Materials: Three thousand, eight hundred and twelve patients with Stage IB2–IVA cervical cancer diagnosed from 2006 to 2015 treated with external beam radiotherapy were identified from the California Cancer Registry. Chi-square tests were used to compare patient characteristics by marital status and boost type. The association of marital status with brachytherapy (BT)receipt was assessed using multiple logistic regression. Fine and Gray competing risks and Cox proportional hazards regressions were used to estimate cervical cancer–specific survival (CCSS)and overall survival (OS), respectively. Results: Most women were unmarried (58.8%). Half (50.4%)received BT, while 33.1% received no boost; most (86.3%)received chemotherapy. Unmarried women had similar odds of receiving BT as married women (OR = 1.07, 95% CI: 0.90-1.28, p = 0.4370)but were less likely to receive chemotherapy (84.3% vs. 89.1%, p < 0.0001). Singlehood was significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.03-1.42, p < 0.0174)and OS (hazard ratio = 1.18, 95% CI: 1.03-1.36, p < 0.0153). Not receiving a radiation boost was also significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.02-1.43, p = 0.0317)and OS (hazard ratio = 1.21, 95% CI: 1.05-1.40, p = 0.0100). Conclusions: There were no differences in BT receipt in married vs. unmarried patients. However, unmarried patients had worse CCSS and OS and were less likely to receive chemotherapy. Interventions targeting social factors are needed to improve outcomes in this vulnerable population.

AB - Purpose: Marriage has been associated with enhanced survival among cancer patients, but conflicting correlations have been suggested in cervical cancer. We assessed the impact of marital status on receipt of brachytherapy and survival in women with locally advanced cervical cancer. Methods and Materials: Three thousand, eight hundred and twelve patients with Stage IB2–IVA cervical cancer diagnosed from 2006 to 2015 treated with external beam radiotherapy were identified from the California Cancer Registry. Chi-square tests were used to compare patient characteristics by marital status and boost type. The association of marital status with brachytherapy (BT)receipt was assessed using multiple logistic regression. Fine and Gray competing risks and Cox proportional hazards regressions were used to estimate cervical cancer–specific survival (CCSS)and overall survival (OS), respectively. Results: Most women were unmarried (58.8%). Half (50.4%)received BT, while 33.1% received no boost; most (86.3%)received chemotherapy. Unmarried women had similar odds of receiving BT as married women (OR = 1.07, 95% CI: 0.90-1.28, p = 0.4370)but were less likely to receive chemotherapy (84.3% vs. 89.1%, p < 0.0001). Singlehood was significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.03-1.42, p < 0.0174)and OS (hazard ratio = 1.18, 95% CI: 1.03-1.36, p < 0.0153). Not receiving a radiation boost was also significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.02-1.43, p = 0.0317)and OS (hazard ratio = 1.21, 95% CI: 1.05-1.40, p = 0.0100). Conclusions: There were no differences in BT receipt in married vs. unmarried patients. However, unmarried patients had worse CCSS and OS and were less likely to receive chemotherapy. Interventions targeting social factors are needed to improve outcomes in this vulnerable population.

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