Disparities Among Cervical Cancer Patients Receiving Brachytherapy.
Identifieur interne : 000401 ( Main/Corpus ); précédent : 000400; suivant : 000402Disparities Among Cervical Cancer Patients Receiving Brachytherapy.
Auteurs : Shaina F. Bruce ; Tanvi V. Joshi ; Inna Chervoneva ; Misung Yi ; Sudeshna Chatterjee-Paer ; Elizabeth R. Burton ; Mitchell I. Edelson ; Joel I. Sorosky ; Mark S. ShahinSource :
- Obstetrics and gynecology [ 1873-233X ] ; 2019.
English descriptors
- KwdEn :
- Adult (MeSH), African Americans (statistics & numerical data), Aged (MeSH), Brachytherapy (statistics & numerical data), Continental Population Groups (statistics & numerical data), Female (MeSH), Healthcare Disparities (ethnology), Healthcare Disparities (statistics & numerical data), Hispanic Americans (statistics & numerical data), Humans (MeSH), Insurance Coverage (statistics & numerical data), Insurance, Health (statistics & numerical data), Middle Aged (MeSH), Odds Ratio (MeSH), Proportional Hazards Models (MeSH), Retrospective Studies (MeSH), United States (MeSH), Uterine Cervical Neoplasms (ethnology), Uterine Cervical Neoplasms (radiotherapy).
- MESH :
- geographic : United States.
- ethnology : Healthcare Disparities, Uterine Cervical Neoplasms.
- radiotherapy : Uterine Cervical Neoplasms.
- statistics & numerical data : African Americans, Brachytherapy, Continental Population Groups, Healthcare Disparities, Hispanic Americans, Insurance Coverage, Insurance, Health.
- Adult, Aged, Female, Humans, Middle Aged, Odds Ratio, Proportional Hazards Models, Retrospective Studies.
Abstract
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.
DOI: 10.1097/AOG.0000000000003401
PubMed: 31403593
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Joshi</name></author><author><name sortKey="Chervoneva, Inna" sort="Chervoneva, Inna" uniqKey="Chervoneva I" first="Inna" last="Chervoneva">Inna Chervoneva</name></author><author><name sortKey="Yi, Misung" sort="Yi, Misung" uniqKey="Yi M" first="Misung" last="Yi">Misung Yi</name></author><author><name sortKey="Chatterjee Paer, Sudeshna" sort="Chatterjee Paer, Sudeshna" uniqKey="Chatterjee Paer S" first="Sudeshna" last="Chatterjee-Paer">Sudeshna Chatterjee-Paer</name></author><author><name sortKey="Burton, Elizabeth R" sort="Burton, Elizabeth R" uniqKey="Burton E" first="Elizabeth R" last="Burton">Elizabeth R. Burton</name></author><author><name sortKey="Edelson, Mitchell I" sort="Edelson, Mitchell I" uniqKey="Edelson M" first="Mitchell I" last="Edelson">Mitchell I. Edelson</name></author><author><name sortKey="Sorosky, Joel I" sort="Sorosky, Joel I" uniqKey="Sorosky J" first="Joel I" last="Sorosky">Joel I. Sorosky</name></author><author><name sortKey="Shahin, Mark S" sort="Shahin, Mark S" uniqKey="Shahin M" first="Mark S" last="Shahin">Mark S. Shahin</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2019">2019</date><idno type="RBID">pubmed:31403593</idno><idno type="pmid">31403593</idno><idno type="doi">10.1097/AOG.0000000000003401</idno><idno type="wicri:Area/Main/Corpus">000401</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000401</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Disparities Among Cervical Cancer Patients Receiving Brachytherapy.</title><author><name sortKey="Bruce, Shaina F" sort="Bruce, Shaina F" uniqKey="Bruce S" first="Shaina F" last="Bruce">Shaina F. Bruce</name><affiliation><nlm:affiliation>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.</nlm:affiliation></affiliation></author><author><name sortKey="Joshi, Tanvi V" sort="Joshi, Tanvi V" uniqKey="Joshi T" first="Tanvi V" last="Joshi">Tanvi V. Joshi</name></author><author><name sortKey="Chervoneva, Inna" sort="Chervoneva, Inna" uniqKey="Chervoneva I" first="Inna" last="Chervoneva">Inna Chervoneva</name></author><author><name sortKey="Yi, Misung" sort="Yi, Misung" uniqKey="Yi M" first="Misung" last="Yi">Misung Yi</name></author><author><name sortKey="Chatterjee Paer, Sudeshna" sort="Chatterjee Paer, Sudeshna" uniqKey="Chatterjee Paer S" first="Sudeshna" last="Chatterjee-Paer">Sudeshna Chatterjee-Paer</name></author><author><name sortKey="Burton, Elizabeth R" sort="Burton, Elizabeth R" uniqKey="Burton E" first="Elizabeth R" last="Burton">Elizabeth R. Burton</name></author><author><name sortKey="Edelson, Mitchell I" sort="Edelson, Mitchell I" uniqKey="Edelson M" first="Mitchell I" last="Edelson">Mitchell I. Edelson</name></author><author><name sortKey="Sorosky, Joel I" sort="Sorosky, Joel I" uniqKey="Sorosky J" first="Joel I" last="Sorosky">Joel I. Sorosky</name></author><author><name sortKey="Shahin, Mark S" sort="Shahin, Mark S" uniqKey="Shahin M" first="Mark S" last="Shahin">Mark S. Shahin</name></author></analytic><series><title level="j">Obstetrics and gynecology</title><idno type="eISSN">1873-233X</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>African Americans (statistics & numerical data)</term><term>Aged (MeSH)</term><term>Brachytherapy (statistics & numerical data)</term><term>Continental Population Groups (statistics & numerical data)</term><term>Female (MeSH)</term><term>Healthcare Disparities (ethnology)</term><term>Healthcare Disparities (statistics & numerical data)</term><term>Hispanic Americans (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Insurance Coverage (statistics & numerical data)</term><term>Insurance, Health (statistics & numerical data)</term><term>Middle Aged (MeSH)</term><term>Odds Ratio (MeSH)</term><term>Proportional Hazards Models (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>United States (MeSH)</term><term>Uterine Cervical Neoplasms (ethnology)</term><term>Uterine Cervical Neoplasms (radiotherapy)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="ethnology" xml:lang="en"><term>Healthcare Disparities</term><term>Uterine Cervical Neoplasms</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Uterine Cervical Neoplasms</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>African Americans</term><term>Brachytherapy</term><term>Continental Population Groups</term><term>Healthcare Disparities</term><term>Hispanic Americans</term><term>Insurance Coverage</term><term>Insurance, Health</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Odds Ratio</term><term>Proportional Hazards Models</term><term>Retrospective Studies</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31403593</PMID><DateCompleted><Year>2020</Year><Month>03</Month><Day>23</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>23</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1873-233X</ISSN><JournalIssue CitedMedium="Internet"><Volume>134</Volume><Issue>3</Issue><PubDate><Year>2019</Year><Month>09</Month></PubDate></JournalIssue><Title>Obstetrics and gynecology</Title><ISOAbbreviation>Obstet Gynecol</ISOAbbreviation></Journal><ArticleTitle>Disparities Among Cervical Cancer Patients Receiving Brachytherapy.</ArticleTitle><Pagination><MedlinePgn>559-569</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/AOG.0000000000003401</ELocationID><Abstract><AbstractText Label="OBJECTIVE">To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer.</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bruce</LastName><ForeName>Shaina F</ForeName><Initials>SF</Initials><AffiliationInfo><Affiliation>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.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Joshi</LastName><ForeName>Tanvi V</ForeName><Initials>TV</Initials></Author><Author ValidYN="Y"><LastName>Chervoneva</LastName><ForeName>Inna</ForeName><Initials>I</Initials></Author><Author ValidYN="Y"><LastName>Yi</LastName><ForeName>Misung</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Chatterjee-Paer</LastName><ForeName>Sudeshna</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Burton</LastName><ForeName>Elizabeth R</ForeName><Initials>ER</Initials></Author><Author ValidYN="Y"><LastName>Edelson</LastName><ForeName>Mitchell I</ForeName><Initials>MI</Initials></Author><Author ValidYN="Y"><LastName>Sorosky</LastName><ForeName>Joel I</ForeName><Initials>JI</Initials></Author><Author ValidYN="Y"><LastName>Shahin</LastName><ForeName>Mark S</ForeName><Initials>MS</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>P30 CA056036</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D023362">Evaluation Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Obstet Gynecol</MedlineTA><NlmUniqueID>0401101</NlmUniqueID><ISSNLinking>0029-7844</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001741" MajorTopicYN="N">African Americans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001918" MajorTopicYN="N">Brachytherapy</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D044469" MajorTopicYN="N">Continental Population Groups</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054625" MajorTopicYN="N">Healthcare Disparities</DescriptorName><QualifierName UI="Q000208" MajorTopicYN="N">ethnology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006630" MajorTopicYN="N">Hispanic Americans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019458" MajorTopicYN="N">Insurance Coverage</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007348" MajorTopicYN="N">Insurance, Health</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016017" MajorTopicYN="N">Odds Ratio</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016016" MajorTopicYN="N">Proportional Hazards Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002583" MajorTopicYN="N">Uterine Cervical Neoplasms</DescriptorName><QualifierName UI="Q000208" MajorTopicYN="N">ethnology</QualifierName><QualifierName UI="Q000532" MajorTopicYN="Y">radiotherapy</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>8</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>3</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>8</Month><Day>13</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31403593</ArticleId><ArticleId IdType="doi">10.1097/AOG.0000000000003401</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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