Multi-Institutional Evaluation of Health Disparities in Rural Cervical Cancer Patients

Abstract

<h3>Purpose/Objective(s)</h3> Cervical cancer remains a significant concern for both rural and urban populations in the US. Overall treatment time from the start of chemoradiation to completion of brachytherapy is known to correlate with local control and overall survival. Rural populations experience health disparities which are multi-factorial and vary by region, but a commonality is lack of healthcare access and distance to tertiary care centers. The purpose of this study is to examine the health disparities due to geographic location for women with locally advanced cervical cancer (LACC) presenting to tertiary care facilities and identify factors that influence their treatment and outcomes. <h3>Materials/Methods</h3> A multi-institutional retrospective cohort study was conducted including data from 5 tertiary care centers across the United States. Women with LACC defined as FIGO 2018 IB3-IVA treated with definitive intent RT ±chemotherapy from Jan 2011 to Jan 2021 were included. Clinical, pathologic, radiologic, demographic, and treatment parameters as well as disease outcomes were collected. Geographic location was collected, and zip code was used to determine urban (pop ≥10,000) or rural (pop <10,000) residency. Univariate analyses were used to determine the effects of these variables on disease outcomes. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method. <h3>Results</h3> 613 patients were included from diverse regions of the country. Median OS was 27 months (range 0-133) and median RFS was 19.4 months (range 0-123.5). Urban (N=534, 87%) or rural (N=79, 13%) residence was not correlated with overall treatment time (p = 0.50) or cervical cancer specific survival (p = 0.32). The median time from diagnosis to start of RT was significantly shorter in the rural patient population than in the urban population (28 days v. 41 days, p = 0.002). There was no significant association between time from diagnosis to start of RT and cervical cancer specific survival (p = 0.07) or between overall treatment time and cervical cancer specific survival (p = 0.26). There was, however, a significant association between overall treatment time and time to recurrence, with each day of increase in treatment time leading to a 1.1% increased risk of recurrence (p = 0.03, HR = 1.011). <h3>Conclusion</h3> In this group of patients we found no differences in treatment time or outcomes between urban and rural residents and surprisingly, rural patients had a shorter median time from diagnosis to start of treatment when compared to the urban patient group. As is already known, there was a significant relationship between treatment time and time to recurrence, highlighting the importance of timely treatment in patients with LACC. We are adding data from several more centers and will be evaluating the populations with more granularity to identify challenges faced by our patients and resources that may be helpful.