Disparities in the management and outcomes of cervical carcinoma: A multi-institutional database analysis (518)

Abstract

<b>Objectives:</b> To investigate the presence of disparities in the management of patients with cervical cancer and their impact on survival outcomes. <b>Methods:</b> The National Cancer Database was accessed, and Black or non-Hispanic White (NHW) patients with no history of another tumor diagnosed between 2004 and 2015 with cervical carcinoma were identified. Patients with early-stage (FIGO 2009 stage IB1), locally advanced (FIGO 2009 stage IB2-IVA), and metastatic (FIGO 2009 stage IVB) disease were selected for further analysis. Overall survival (OS) was evaluated for patients who had at least one month of follow-up and compared with the log-rank test. Cox models were constructed to control for a priori selected confounders. <b>Results:</b> A total of 47767 patients were identified; 78% were NHW and 22% were Black. Black patients were more likely to be managed at academic facilities (55.9% vs 41.9%, p<0.001) and reside within 12.5 miles of the treatment facility (67.5% vs 44%, p<0.001). For stage IVB disease, after controlling for confounders, Black patients were less likely to receive chemotherapy (OR: 0.75, 95% CI: 0.65-0.86). Among patients receiving chemotherapy, after controlling for confounders there was no difference in OS between NHW and Black patients (HR: 1.04, 95% CI: 0.95-1.14). For patients with locally advanced disease, after controlling for confounders, Black patients were less likely to receive external beam radiation therapy (EBRT) (OR: 0.90, 95% CI: 0.85-0.95); if EBRT was administered, they were less likely to receive vaginal brachytherapy (VBT) (OR: 0.87, 95% CI: 0.81-0.92) or radio-sensitizing chemotherapy (OR: 0.81, 95% CI: 0.74-0.87). Among patients with locally advanced disease who received EBRT, radio-sensitizing chemotherapy, and VBT, after controlling for confounders there was no difference in OS between NHW and Black patients (HR: 0.97, 95% CI: 0.89-1.05). Black patients with stage IB1 disease, after controlling for confounders, were less likely to undergo hysterectomy/trachelectomy (OR: 0.71, 95% CI: 0.62-0.81), or radical hysterectomy (if they underwent hysterectomy) (OR: 0.87, 95% CI: 0.74-1.00). Black patients undergoing surgery were more likely to have prolonged hospital stay (defined as >5 days) (OR: 1.73, 95% CI: 1.38-2.18) and have unplanned readmission within 30 days from surgery (OR: 1.38, 95% CI: 1.04-1.83). Among patients with stage IB1 disease undergoing radical hysterectomy with lymphadenec- tomy, after controlling for confounders there was no difference in OS between NHW and Black patients (HR: 1.08, 95% CI: 0.80-1.46). <b>Conclusions:</b> While Black patients with cervical cancer were more likely to reside closer to treatment facilities and receive care at academic institutions, they were less likely to receive guideline conformant care compared to NHW regardless of disease stage. For patients receiving guideline conformant care, overall survival was comparable to NHW patients.