Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

Jyoti Mayadev, Amy Klapheke, Catheryn Yashar, I. Chow Hsu, Mitchell Kamrava, Arno J. Mundt, Loren K. Mell, John Einck, Stanley H Benedict, Richard K Valicenti, Rosemary D Cress

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. Methods: Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). Results: We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). Conclusions: The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Brachytherapy
Uterine Cervical Neoplasms
Survival
Radiation
Demography
Registries
Neoplasms
Multivariate Analysis
Logistic Models
Regression Analysis
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. / Mayadev, Jyoti; Klapheke, Amy; Yashar, Catheryn; Hsu, I. Chow; Kamrava, Mitchell; Mundt, Arno J.; Mell, Loren K.; Einck, John; Benedict, Stanley H; Valicenti, Richard K; Cress, Rosemary D.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Mayadev, Jyoti ; Klapheke, Amy ; Yashar, Catheryn ; Hsu, I. Chow ; Kamrava, Mitchell ; Mundt, Arno J. ; Mell, Loren K. ; Einck, John ; Benedict, Stanley H ; Valicenti, Richard K ; Cress, Rosemary D. / Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. In: Gynecologic Oncology. 2018.
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title = "Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California",
abstract = "Purpose: The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. Methods: Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). Results: We identified 4783 patients with FIGO stage 11{\%} IB2; 32{\%} II, 54{\%} III, 3{\%} IVA. Nearly half (45{\%}) of patients were treated with BT, 18{\%} were treated with a EBRT boost, and 37{\%} had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). Conclusions: The utilization of BT in locally advanced cervical cancer was low at 45{\%}, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.",
author = "Jyoti Mayadev and Amy Klapheke and Catheryn Yashar and Hsu, {I. Chow} and Mitchell Kamrava and Mundt, {Arno J.} and Mell, {Loren K.} and John Einck and Benedict, {Stanley H} and Valicenti, {Richard K} and Cress, {Rosemary D}",
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AU - Mayadev, Jyoti

AU - Klapheke, Amy

AU - Yashar, Catheryn

AU - Hsu, I. Chow

AU - Kamrava, Mitchell

AU - Mundt, Arno J.

AU - Mell, Loren K.

AU - Einck, John

AU - Benedict, Stanley H

AU - Valicenti, Richard K

AU - Cress, Rosemary D

PY - 2018/1/1

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N2 - Purpose: The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. Methods: Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). Results: We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). Conclusions: The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.

AB - Purpose: The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. Methods: Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). Results: We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). Conclusions: The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.

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