Brachytherapy plus External Beam Radiation Therapy Utilization Pattern Change between Years 1998-2003 and 2004-2009 Based on SEER Data Analysis

Abstract

Brachytherapy combined with external beam radiation therapy is an important component of definitive treatment of cervix cancer. Our study estimates how the overall change in incidence rates affects the pattern of brachytherapy utilization for cervix cancer. The SEER*Stat 7.0.0 was accessed to identify trends in treatment of cervix cancer using Surveillance Epidemiology and End Results (SEER) 13. Chi-square tests were performed on rate ratios to determine if differences exist among treatment patterns between the two time periods: 1998-2003 and 2004-2009. The incidence of cervical cancer declined from 1998 - 03 to 2004 - 09, (p<0.0001). The overall brachytherapy plus external beam radiation therapy utilization rate for all stages of cervix cancer has decreased (p<0.0001). Subset analysis shows that there was trend to decline but not statistically significant change in rate for stage 1 (p=0.0599). However, there was a significant decrease in utilization rate for stage II, stage III and stage IV (p<0.001) cases. There was no expected change in utilization rate of surgery in stage I cervix cancer (p=0.27). Incidence of cervix cancer is gradually declining in the United States. Our study of SEER data registry confirms decline in overall incidence of cervix cancer over the examined six year time frames. We find an overall decline in cervix cancer brachytherapy plus external beam radiation therapy utilization rate. This change is noted in stage II to stage IV disease. No significant change in the utilization of brachytherapy plus external beam radiation is demonstrated in stage I cases. Correspondingly, no significant change in utilization rate of surgery is noted in stage I. The pattern of decline in the utilization rate of therapy incorporating brachytherapy in locally advanced stages of cervix cancer where it is most needed, is alarming and needs to be further addressed to ensure its availability and appropriate care of the patient.