TY - JOUR
T1 - Delays in definitive cervical cancer treatment
T2 - An analysis of disparities and overall survival impact
AU - Ramey, Stephen J
AU - Asher, David
AU - Kwon, Deukwoo
AU - Ahmed, Awad A.
AU - Wolfson, Aaron H.
AU - Yechieli, Raphael
AU - Portelance, Lorraine
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objective: Delays in time to treatment initiation (TTI) with definitive radiation therapy (RT) or chemotherapy and RT (CRT) for cervical cancer could lead to poorer outcomes. This study investigates disparities in TTI and the impact of TTI on overall survival (OS). Methods: Adult women with non-metastatic cervical squamous cell carcinoma diagnosed between 2004 and 2014, treated with definitive RT or CRT, and reported to the National Cancer Database were included. TTI was defined as days from diagnosis to start of RT or CRT. The impact of TTI on OS in patients treated with concurrent CRT which included brachytherapy was then assessed. Results: Overall, 14,924 patients were included (84.7% CRT, 15.3% RT). TTI was significantly longer for Non-Hispanic Black (NHB) (RR, 1.14; 95% CI, 1.11 to 1.18) and Hispanic women (RR, 1.19; 95% CI, 1.15 to 1.24) compared to Non-Hispanic White (NHW) women. Expected TTI (eTTI) for NHW, NHB, and Hispanic women were 38.1, 45.2, and 49.4 days. eTTI rose from 36.2 days in 2004 to 44.3 days by 2014. Intensity-modulated radiation therapy (IMRT) was associated with increased eTTI of 46.5 days versus 40.0 days for non-IMRT. Longer TTI was not associated with inferior OS in patients treated with concurrent CRT. Conclusions: Delays in starting RT/CRT for cervical cancer increased from 2004 to 2014. Delays disproportionately affect NHB and Hispanic women. However, increased TTI was not associated with increased mortality for women receiving CRT. Further study of TTI's impact on other endpoints is warranted to determine if TTI represents an important quality indicator.
AB - Objective: Delays in time to treatment initiation (TTI) with definitive radiation therapy (RT) or chemotherapy and RT (CRT) for cervical cancer could lead to poorer outcomes. This study investigates disparities in TTI and the impact of TTI on overall survival (OS). Methods: Adult women with non-metastatic cervical squamous cell carcinoma diagnosed between 2004 and 2014, treated with definitive RT or CRT, and reported to the National Cancer Database were included. TTI was defined as days from diagnosis to start of RT or CRT. The impact of TTI on OS in patients treated with concurrent CRT which included brachytherapy was then assessed. Results: Overall, 14,924 patients were included (84.7% CRT, 15.3% RT). TTI was significantly longer for Non-Hispanic Black (NHB) (RR, 1.14; 95% CI, 1.11 to 1.18) and Hispanic women (RR, 1.19; 95% CI, 1.15 to 1.24) compared to Non-Hispanic White (NHW) women. Expected TTI (eTTI) for NHW, NHB, and Hispanic women were 38.1, 45.2, and 49.4 days. eTTI rose from 36.2 days in 2004 to 44.3 days by 2014. Intensity-modulated radiation therapy (IMRT) was associated with increased eTTI of 46.5 days versus 40.0 days for non-IMRT. Longer TTI was not associated with inferior OS in patients treated with concurrent CRT. Conclusions: Delays in starting RT/CRT for cervical cancer increased from 2004 to 2014. Delays disproportionately affect NHB and Hispanic women. However, increased TTI was not associated with increased mortality for women receiving CRT. Further study of TTI's impact on other endpoints is warranted to determine if TTI represents an important quality indicator.
KW - Cervical cancer
KW - Chemoradiation
KW - Disparity
KW - Ethnic
KW - NCDB
KW - Racial
KW - Radiation
UR - http://www.scopus.com/inward/record.url?scp=85044122974&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044122974&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2017.12.010
DO - 10.1016/j.ygyno.2017.12.010
M3 - Article
C2 - 29605051
AN - SCOPUS:85044122974
SN - 0090-8258
VL - 149
SP - 53
EP - 62
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 1
ER -
