scholarly journals Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities

2021 ◽  
pp. OP.21.00291
Author(s):  
David Boyce-Fappiano ◽  
Kevin A. Nguyen ◽  
Olsi Gjyshi ◽  
Gohar Manzar ◽  
Chike O. Abana ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Stage I ◽  
Oncologic Outcomes ◽  
External Beam Radiation ◽  
Insurance Status ◽  
Beam Radiation ◽  
Black And White ◽  
Survival Differences ◽  
The Impact ◽  
White Patients

PURPOSE: Cervical cancer (CC) disproportionately affects minorities who have higher incidence and mortality rates. Standard of care for locally advanced CC involves a multimodality approach including brachytherapy (BT), which independently improves oncologic outcomes. Here, we examine the impact of insurance status and race on BT utilization with the SEER database. MATERIALS AND METHODS: In total, 7,266 patients with stage I-IV CC diagnosed from 2007 to 2015 were included. BT utilization, overall survival (OS), and disease-specific survival (DSS) were compared. RESULTS: Overall, 3,832 (52.7%) received combined external beam radiation therapy (EBRT) + BT, whereas 3,434 (47.3%) received EBRT alone. On multivariate logistic regression analysis, increasing age (OR, 0.98; 95% CI, 0.98 to 0.99; P < .001); Medicaid (OR, 0.80; 95% CI, 0.72 to 0.88; P < .001), uninsured (OR, 0.67; 95% CI, 0.56 to 0.80; P < .001), and unknown versus private insurance (OR, 0.61; 95% CI, 0.43 to 0.86; P < .001); Black (OR, 0.68; 95% CI, 0.60 to 0.77; P < .001) and unknown versus White race (OR, 0.30; 95% CI, 0.13 to 0.77; P = .047); and American Joint Committee on Cancer stage II (OR, 1.07; 95% CI, 0.93 to 1.24; P = .36), stage III (OR, 0.82; 95% CI, 0.71 to 0.94; P = .006), stage IV (OR, 0.30; 95% CI, 0.23 to 0.40; P < .001), and unknown stage versus stage I (OR, 0.36; 95% CI, 0.28 to 0.45; P < .001) were associated with decreased BT utilization. When comparing racial survival differences, the 5-year OS was 44.2% versus 50.9% ( P < .0001) and the 5-year DSS was 55.6% versus 60.5% ( P < .0001) for Black and White patients, respectively. Importantly, the racial survival disparities resolved when examining patients who received combined EBRT + BT, with the 5-year OS of 57.3% versus 58.5% ( P = .24) and the 5-year DSS of 66.3% versus 66.6% ( P = .53) for Black and White patients, respectively. CONCLUSION: This work demonstrates notable inequities in BT utilization for CC that particularly affects patients of lower insurance status and Black race, which translates into inferior oncologic outcomes. Importantly, the use of BT was able to overcome racial survival differences, thus highlighting its essential value.

The impact of clinical trial evidence and sociodemographic factors on institutional practice patterns for stage I testicular cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 372-372
Author(s):  
Gautum Agarwal ◽  
Oscar Valderamma ◽  
Sabine Nguyen ◽  
Adam Luchey ◽  
Julio Pow-Sang ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Sociodemographic Factors ◽  
Education Level ◽  
Stage I ◽  
External Beam Radiation ◽  
Retroperitoneal Lymph Node Dissection ◽  
Beam Radiation ◽  
Therapeutic Decisions ◽  
Multiple Variables ◽  
The Impact

372 Background: Contemporary management for patients with stage I testicular cancer (TC) continues to evolve. Survival is dependent upon staging, surveillance, and the treatment(s) rendered. We sought to determine whether treatment recommendations have been impacted by evidence gained from recent clinical trials and how sociodemographic factors might affect therapeutic decisions for patients with stage I pure seminoma (PS) and nonseminoma (NSGCT). Methods: We performed a single institution, institutional review board approved, retrospective review of patients evaluated for TC from 1999 to 2013. Chi-square and logistic regression analyses were performed between multiple variables including: type of treatment, specialty of the provider, year of treatment, insurance status, distance traveled to our hospital, and education level. Results: Four hundred forty patients were evaluated; of this group 121 patients had stage I TC. For NSGCT patients, living further than 50 miles from our center was associated with treatment (p=0.013). NSGCT patients who had completed an undergraduate education were more likely to undergo surveillance compared to those with a high school education (p<0.01). If intervention was recommended, NSGCT patients evaluated prior to 2010 were more likely to undergo primary retroperitoneal lymph node dissection (RPLND) (p<0.01). After 2010 these patients were more likely to have primary chemotherapy (PC) (p<0.01). NSGCT patients evaluated by urologic oncologists had higher RPLND rates while patients evaluated by medical oncologists more often received PC (p<0.01). The percentage of PS patients receiving external beam radiation decreased from 40% to 5% after 2010, while the rate of surveillance increased from 47% to 79% (p=0.016). For all stage I patients the presence of lymphovascular invasion was associated with treatment compared to surveillance (p<0.001). Conclusions: The management of patients with stage I TC has changed significantly over the past decade. In our study, management recommendations have been shown to be dependent upon the specialty of the provider and other social factors such as distance from the hospital as well as education level, which suggests the possibility of bias during patient counseling.

scholarly journals Effects of HIV status on non-metastatic cervical cancer progression among patients in Lusaka, Zambia

2020 ◽  
Vol 30 (5) ◽  
pp. 613-618
Author(s):  
Mario Jesus Trejo ◽  
Kennedy Lishimpi ◽  
Mulele Kalima ◽  
Catherine K Mwaba ◽  
Lewis Banda ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Stage I ◽  
External Beam Radiation ◽  
Hiv Positive ◽  
External Beam ◽  
Hiv Status ◽  
Beam Radiation ◽  
Hiv Negative

IntroductionSub-Saharan Africa has the highest global incidence of cervical cancer. Cervical cancer is the most common cause of cancer morbidity and mortality among women in Zambia. HIV increases the risk for cervical cancer and with a national Zambian adult HIV prevalence of 16%, it is important to investigate the impact of HIV on the progression of cervical cancer. We measured differences in cervical cancer progression between HIV-positive and HIV-negative patients in Zambia.MethodsThis study included 577 stage I and II cervical cancer patients seen between January 2008 and December 2012 at the Cancer Diseases Hospital in Lusaka, Zambia. The inclusion criteria for records during the study period included known HIV status and FIGO stage I and II cervical cancer at initial date of registration in the Cancer Diseases Hospital. Medical records were abstracted for clinical and epidemiological data. Cancer databases were linked to the national HIV database to assess HIV status among cervical cancer patients. Logistic regression examined the association between HIV and progression, which was defined as metastatic or residual tumor after 3 months of initial treatment.ResultsA total of 2451 cervical cancer cases were identified, and after exclusion criteria were performed the final analysis population totaled 537 patients with stage I and II cervical cancer with known HIV status (224 HIV-positive and 313 HIV-negative). HIV-positive women were, on average, 10 years younger than HIV-negative women who had a median age of 42, ranging between 25 and 72. A total of 416 (77.5%) patients received external beam radiation, and only 249 (46.4%) patients received the recommended treatment of chemotherapy, external beam radiation, and brachytherapy. Most patients were stage II (85.7%) and had squamous cell carcinoma (74.7%). HIV-positive patients were more likely to receive lower doses of external beam radiation than HIV-negative patients (47% vs 37%; P<0.05, respectively). The median total dose of external beam radiation for HIV-positive and HIV-negative patients was 46 Gy and 50 Gy, respectively. HIV positivity did not lead to tumor progression (25.4% in HIV-positive vs 23.9% in HIV-negative, OR 1.04, 95% CI [0.57, 1.92]). However, among a subset of HIV-positive patients, longer duration of infection was associated with lower odds of progression.ConclusionThere was no significant impact on non-metastatic cervical cancer progression by HIV status among patients in Lusaka, Zambia. The high prevalence of HIV among cervical cancer patients suggest that HIV-positive patients should be a primary target group for HPV vaccinations, screening, and early detection.

scholarly journals PROTECT: Prospective Phase-II-Trial Evaluating Adaptive Proton Therapy for Cervical Cancer to Reduce the Impact on Morbidity and the Immune System

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5179
Author(s):  
Anouk Corbeau ◽  
Remi A. Nout ◽  
Jan Willem M. Mens ◽  
Nanda Horeweg ◽  
Jérémy Godart ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Phase Ii ◽  
Proton Therapy ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Intensity Modulated ◽  
The Impact

External beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy is a very effective treatment for locally advanced cervical cancer (LACC). However, treatment-related toxicity is common and reduces the patient’s quality of life (QoL) and ability to complete treatment or undergo adjuvant therapies. Intensity modulated proton therapy (IMPT) enables a significant dose reduction in organs at risk (OAR), when compared to that of standard intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). However, clinical studies evaluating whether IMPT consequently reduces side effects for LACC are lacking. The PROTECT trial is a nonrandomized prospective multicenter phase-II-trial comparing clinical outcomes after IMPT or IMRT/VMAT in LACC. Thirty women aged >18 years with a histological diagnosis of LACC will be included in either the IMPT or IMRT/VMAT group. Treatment includes EBRT (45 Gy in 25 fractions of 1.8 Gy), concurrent five weekly cisplatin (40 mg/m2), and 3D image (MRI)-guided adaptive brachytherapy. The primary endpoint is pelvic bones Dmean and mean bowel V15Gy. Secondary endpoints include dosimetric parameters, oncological outcomes, health-related QoL, immune response, safety, and tolerability. This study provides the first data on the potential of IMPT to reduce OAR dose in clinical practice and improve toxicity and QoL for patients with LACC.

Adjuvant Radiation for Gynecologic Cancers

2019 ◽  
Author(s):  
Joanne Jang
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Vulvar Cancer ◽  
Vaginal Cancer ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Postoperative Setting

Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery. This review contains 5 figures, and 4 tables, and 40 references.  Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer

scholarly journals Treatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala

2019 ◽  
pp. 1-5 ◽  
Author(s):  
Abigail S. Zamorano ◽  
Joaquin Barnoya ◽  
Eduardo Gharzouzi ◽  
Camaryn Chrisman Robbins ◽  
Emperatriz Orozco ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Access To Care ◽  
Cancer Treatment ◽  
Patient Population ◽  
Treatment Compliance ◽  
External Beam Radiation ◽  
Cervical Cancer Patient ◽  
Beam Radiation ◽  
Lost To Follow Up

PURPOSE Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes. METHODS A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated. RESULTS Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded. CONCLUSION The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.

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