Conference Coverage

Brachytherapy access may mediate poor cervical cancer survival in blacks


 

REPORTING FROM SGO 2019

Increasing access to brachytherapy for black patients with locally advanced cervical cancer may reduce racial disparities in survival, according to a speaker at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.

Dr. Stephanie Alimena of Brigham and Women’s Hospital, Boston

Dr. Stephanie Alimena

Stephanie Alimena, MD, of Brigham and Women’s Hospital in Boston, presented a large, retrospective study showing that use of brachytherapy mediated survival differences by race.

In the absence of brachytherapy, black patients had a significantly higher risk of death than did non-black patients (P = .013). However, when brachytherapy was used, black and non-black patients had a similar risk of death (P = .83).

“[W]e know that use of a brachytherapy boost is associated with improved patient outcomes, including improved cancer-specific and overall survival,” Dr. Alimena said. “We also know that African-American women have one of the highest incidences of cervical cancer in the United States and also have worse mortality from cervical cancer.”

“Studies have reached varying conclusions about the impact of race on brachytherapy utilization, with several smaller studies suggesting that minority women may be less likely to receive brachytherapy services compared to white women. No studies have specifically examined the interaction between race, radiation, and survival.”

Dr. Alimena and her colleagues decided to examine the interaction using data from the National Cancer Database. The researchers evaluated 15,411 women diagnosed with cervical cancer from 2004 to 2014. The patients had stage IB2 to IVA disease, their mean age was 54 years (range, 19-90), 58% had received brachytherapy, and 19% were black.

“Race was defined as black or non-black race, given that previous data had shown similar and even increased survival rates for Hispanic and Asian-American women compared to white patients diagnosed with cervical cancer,” Dr. Alimena noted.

Differences by race

The researchers found that black patients were significantly less likely to receive brachytherapy than were non-black patients: 52.5% vs. 59.0%, respectively (P less than .001).

Black patients were significantly more likely to have stage III disease (42.7% vs. 37.6%; P less than .001) and less likely to have stage IVA disease (6.8% vs. 7.3%; P less than .001).

Black patients were significantly more likely to have government insurance (57.0% vs. 49.1%; P less than .001) and less likely to have private insurance (27.6% vs. 36.7%; P less than .001).

And black patients were significantly more likely to have annual incomes below $38,000 (49.4% vs. 22.6%; P less than .001).

Factors associated with brachytherapy

In a multivariate analysis, black race was significantly associated with a reduced likelihood of receiving brachytherapy. The odds ratio (OR) was 0.86 (P = .003).

Other factors significantly associated with a reduced likelihood of receiving brachytherapy were:

  • Being older than 70 years (OR = 0.59; P less than .001)
  • Having government insurance (OR = 0.89; P = .008) or no insurance/unknown insurance status (OR = 0.75; P less than .001)
  • Having stage III disease (OR = 0.47; P less than .001) or stage IVA disease (OR = 0.20; P less than .001)
  • Being treated in southern states (OR = 0.67; P less than .001) or western states (OR = 0.86; P = .02)
  • Having a Charlson/Deyo score of 2 or more (OR = 0.73; P less than .001).

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