Impact of Race and Socioeconomic Factors on Clinical Outcomes in Cervical and Endometrial Cancer Patients Treated with Brachytherapy

Abstract

Racial and socioeconomic disparities impact cancer care and outcomes. This project aimed to evaluate relationship between race and socioeconomic factors and clinical outcomes in patients with cervical and endometrial cancer. All cervical and endometrial cancer patients treated with brachytherapy at our institution from 2007-2017 were identified. Race, insurance status, employment status, disability status, and distance from brachytherapy center were recorded. Clinical characteristics including stage at presentation, number of involved nodes, histology, and brachytherapy technique (cervical cancer only) were recorded. PFS and OS were calculated from date of last brachytherapy fraction, with censorship at date of last follow-up. Correlation was tested between race and socioeconomic factors and PFS and OS using Cox regression models. Association with other outcomes was examined with Wilcoxon rank sum tests, Fisher's exact tests, and Spearman's rank correlation coefficients. A total of 251 cervical and 130 endometrial cancer patients were identified, with median follow-up 5.2 years and 4.8 years, respectively. For cervical cancer, UVA showed significant correlation for PFS and OS with race, insurance status, employment status, and disability status. For endometrial cancer, UVA showed significant correlation for PFS with race, insurance status, and disability status, and for OS with race and insurance status. For cervical cancer, MVA showed significantly improved PFS in patients with insurance (p < 0.001) and patients who were employed (p = 0.002), and significantly improved OS in patients who were white (p = 0.039), patients with insurance (p<0.001), and patients who were employed (p-0.001). For endometrial cancer, MVA showed significantly improved PFS and OS in patients who were white (p = 0.003 and p = 0.005, respectively) and patients with insurance (p = 0.027 and p = 0.002, respectively). For cervical cancer, there was no correlation between insurance or employment status and stage. For endometrial cancer, there was no correlation between race or insurance status and stage. For cervical cancer, insurance and employment status are significant predictors of PFS and OS, and race is additionally a significant predictor of OS. For endometrial cancer, race and insurance status are significant predictors of PFS and OS.