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Disparities Among Cervical Cancer Patients Receiving Brachytherapy

Bruce, Shaina F. MD; Joshi, Tanvi V. MD; Chervoneva, Inna PhD; Yi, Misung PhD; Chatterjee-Paer, Sudeshna MD; Burton, Elizabeth R. MD; Edelson, Mitchell I. MD; Sorosky, Joel I. MD; Shahin, Mark S. MD

doi: 10.1097/AOG.0000000000003401
Contents: Gynecologic Oncology: Original Research

OBJECTIVE: To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer.

METHODS: This is a retrospective cohort study of the National Cancer Database. We identified 25,223 patients diagnosed with stage IB2 through IVA cervical cancer who received radiation therapy during their primary treatment from 2004 to 2015. A univariate analysis was used to assess covariate association with brachytherapy. A multivariable regression model was used to evaluate the effect of race and insurance status on rates of brachytherapy treatment. The Cox proportional hazards model and the multiplicative hazard model were used to evaluate overall survival. P<.05 indicated a statistically significant difference for comparisons of primary and secondary outcomes.

RESULTS: Non-Hispanic black patients received brachytherapy at a significantly lower rate than non-Hispanic white patients (odds ratio [OR] 0.93; 95% CI 0.86–0.99; P=.036); Hispanic (OR 0.93; 95% CI 0.85–1.02; P=.115) and Asian (OR 1.13; 95% CI 0.99–1.29; P=.074) patients received brachytherapy at similar rates. Compared with patients with private insurance, those who were uninsured (OR 0.72; 95% CI 0.65–0.79; P<.001), had Medicaid (OR 0.83; 95% CI 0.77–0.89; P<.001) or Medicare insurance (OR 0.85; 95% CI 0.78–0.92; P<.001) were less likely to receive brachytherapy. Brachytherapy was not found to be a mediator of race and insurance-related disparities in overall survival.

CONCLUSION: Racial and insurance disparities exist for those who receive brachytherapy, with many patients not receiving the standard of care, but overall survival was not affected.

Racial and insurance disparities exist among patients who qualify for brachytherapy for treatment of their cervical cancer, yet overall survival was not affected.

Department of Obstetrics and Gynecology, Abington Hospital-Jefferson Health, Abington, the Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and the Hanjani Institute for Gynecologic Oncology, Asplundh Cancer Pavilion, Abington Hospital-Jefferson Health, Willow Grove, Pennsylvania.

Corresponding author: Shaina F. Bruce, MD, Department of Obstetrics and Gynecology, Abington, PA; email:

Financial Disclosure Inna Chervoneva and Misung Yi report having money paid to their institution from NIH/NCI. Mitchell I. Edelson has received payment by Blumberg & Wolk, LLC and Post & Schell, P.C. to serve as an expert witness for legal cases. His wife is an employee of Merck and receives a salary. Mark S. Shahin has received payment for serving on the speaker's bureau for Tesaro, Merck, Astra Zeneca, and Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented as a poster at the Society of Gynecologic Oncology's Winter Meeting, January 16–19, 2019, Lake Tahoe, California.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.