Trends in Utilization of Brachytherapy in Cervical Cancer in a Single Military Medical Center [37R

Abstract

INTRODUCTION: Standard of care (SOC) treatment for locally advanced cervical cancer consists of chemotherapy, external beam radiation and brachytherapy. Despite significant survival benefits, there is a national decline in utilization of brachytherapy in recent years. Currently only 44% of US patients with locally advanced cervical cancer receive brachytherapy. We believe military medicine and our military medical center has avoided this trend and correctly administers SOC treatment for locally advanced non-operable cervical cancer. METHODS: We utilized the Brooke Army Medical Center Tumor Registry to identify women with locally advanced cervical cancer between January 1997 and March 2018. We reviewed medical records to determine if they received SOC treatment as well as potential associated demographic factors. Data was then analyzed using logistic regression models. (IRB approval was obtained). RESULTS: We found that of the 147 patients with cervical cancer, 36 had locally advanced cervical cancer, 28 (77.8%) met SOC treatment. We found no statistically significant associated factors to include race, rank, duty status, or stage. Reasons for not completing SOC treatment included vesico-vaginal and recto-vaginal fistulas, declining treatment, and rare histologies. CONCLUSION: Our military institution has nearly double the rate of SOC brachytherapy compared to national use. Although we have a small sample size we expect that these trends would be consistent across military medical centers. The contribution of economic and social factors that decrease use of brachytherapy nationwide may be mitigated by the equal access to care provided by military medicine, and the decrease in out of pocket expenses by military beneficiaries at military facilities.