Does social vulnerability impact cervical cancer patients undergoing definitive irradiation including brachytherapy? A single institution’s experience (283)

Abstract

<b>Objectives:</b> There are significant disparities in access to care and treatment among cervical cancer patients. Less than half of patients with locally advanced cervical cancer receive the standard of care therapy consisting of concurrent chemoradiation, followed by brachytherapy, despite significantly improved overall survival based on an analysis of the National Cancer Database. The recommended time to complete radiation therapy in advanced cervical cancer patients is < 56 days, with both pelvic control and survival decreasing when the duration of treatment is lengthened. This study explored the relationship between social vulnerability and clinical variables, including radiation treatment duration in cervical cancer patients undergoing definitive chemoradiation, including brachytherapy over a nine-year period at a single institution. <b>Methods:</b> By querying a cohort discovery tool, data were obtained from 108 patients with cervical cancer from 2012 to 2021 who received brachytherapy in addition to external beam radiation. Patients' census tracts were matched to indices from the Centers for Disease Control's (CDC) Social Vulnerability Index (SVI). The SVI rankings range from least vulnerable, 0, to most vulnerable, 1, for four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Clinical data, such as stage, histology, and demographic factors, were investigated. Results were analyzed using the Kruskal-Wallis rank-sum test Fisher's exact test, and Spearman's correlation. <b>Results:</b> Of patients included, 69% were Caucasian, 20% African American, 6.5% Hispanic, 1.9% Asian, and 1.9% American Indian/ Alaskan Native. The median SVI value when comparing patients to all census tracts in the United States was 0.43 (range: 0.0001-0.9907) in this population. Median SVI values suggested that African American patients were most vulnerable with an SVI of 0.86 (Interquartile Range [IQR]: 0.77-0.94), followed by Hispanic 0.59 (IQR: 0.46-0.79), American Indian or Alaska Native 0.56 (IQR: 0.43-0.69), Asian 0.33 (IQR: 0.22-0.44), and Caucasian 0.31 (IQR: 0.11-0.53) (p <0.001). Using 2018 FIGO staging, 58% of patients were stage III. Stage IV patients had the highest social vulnerability (0.77, IQR: 0.6-0.9). In a subset analysis of radiation treatment duration, the median time from start to end of radiation was 53 days (range: 35-127 days). There was no significant difference in length of time of radiation treatment by race (p=0.3) or stage (p>0.9). There was no relationship between SVI and radiation treatment duration (Rs =0.1). <b>Conclusions:</b> While social vulnerability appears to impact cervical cancer patients in regards to race and stage, increased social vulnerability was not associated with increased radiation treatment duration. Other factors, such as time to diagnosis, initiation of treatment, or accessibility to follow-up, may be more reflective of social vulnerability than treatment duration when a committed team works to mitigate obstacles to care during the course of radiation.