Improved survival in cervical cancer patients receiving care at National Cancer Institute–designated cancer centers

Abstract

BACKGROUND:Locally advanced cervical cancer (CC) remains lethal in the United States. We investigate the effect of receiving care at an National Cancer Institute-designated cancer center (NCICC) on survival. METHODS: Data for women diagnosed with CC from 2004 to 2016 who received radiation treatment were extracted from the California Cancer Registry (n = 4250). Cox proportional hazards regression models assessed whether (1) receiving care at NCICCs was associated with risk of CC-specific death, (2) this association remained after multivariable adjustment for age, race/ethnicity, and insurance status, and (3) this association was explained by receipt of guidelineconcordant treatment. RESULTS: Median age was 50 years (interquartile range [IQR] 41-61 years), with median follow-up of 2.7 years (IQR 1.3-6.0 years). One-third of patients were seen at an NCICC, and 29% died of CC. The hazard of CC-specific death was reduced by 20% for those receiving care at NCICCs compared with patients receiving care elsewhere (HR = .80; 95% CI, 0.70-0.90). Adjustment for guidelineconcordant treatment and other covariates minimally attenuated the association to 0.83 (95% CI, 0.74-0.95), suggesting that the survival advantage associated with care at NCICCs may not be due to receipt of guideline-concordant treatment. CONCLUSIONS: This study demonstrates survival benefit for patients receiving care at NCICCs compared with those receiving care elsewhere that is not explained by differences in guideline-concordant care. Structural, organizational, or provider characteristics and differences in patients receiving care at centers with and without NCI designation could explain observed associations. Further understanding of these factors will promote equality across oncology care facilities and survival equity for patients with CC.

Disparities in Gynecologic Cancers

“…32 The financial, social, and time burdens of the complex multimodal treatments are hardest on disadvantaged populations and introduce many possibilities for substandard care unless needs are addressed directly through navigation or improved care coordination. 33 Delivery of brachytherapy for locally advanced cervical cancer is another important quality metric with documented disparities by race (Black vs. White). [33][34][35][36] Women older than 60 years and those with public insurance or uninsured, care in a nonacademic center, or treatment in the Southern or Western US regions also received less brachytherapy.…”

“…33 Delivery of brachytherapy for locally advanced cervical cancer is another important quality metric with documented disparities by race (Black vs. White). [33][34][35][36] Women older than 60 years and those with public insurance or uninsured, care in a nonacademic center, or treatment in the Southern or Western US regions also received less brachytherapy. 36 Disparities in access to advanced radiation modalities including intensity-modulated radiation therapy lead to long-term toxicities and poorer quality of life.…”

“…One study found Medicaid patients had significant delay from diagnosis to seeing radiation oncology compared with privately insured patients (mean, 76.9 vs. 31.3 days; P = 0.03), and race and age were not significantly associated 32 . The financial, social, and time burdens of the complex multimodal treatments are hardest on disadvantaged populations and introduce many possibilities for substandard care unless needs are addressed directly through navigation or improved care coordination 33 …”

“…Delivery of brachytherapy for locally advanced cervical cancer is another important quality metric with documented disparities by race (Black vs. White) 33–36 . Women older than 60 years and those with public insurance or uninsured, care in a nonacademic center, or treatment in the Southern or Western US regions also received less brachytherapy 36 .…”

Demographic disparities in receipt of care at a comprehensive cancer center

“…For example, one study found that NCICC had lower adjusted surgical mortality rates than control hospitals for certain surgical procedures 2 . Other studies report superior overall survival for patients with newly‐diagnosed cancers at NCICCs versus non‐designated centers 3,4 . Access to clinical trials may contribute to this survival benefit.…”