Updated Trends in Cervical Cancer Brachytherapy Utilization and Disparities in the United States From 2004 to 2020

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IntroductionBrachytherapy utilization decreases are associated with decreased survival. This study examines more recent trends in brachytherapy underutilization from 2004 to 2020 to assess reversal after awareness increased regarding the importance of brachytherapy. MethodsThis study analyzed data from the National Cancer Database (NCDB) of patients with FIGO IB to IVA cervical cancer treated with radiation therapy between 2004 and 2020. To compare brachytherapy utilization over time, 2 to 3-year categories were created to account for potential variation seen in individual years. A multivariate log binomial regression with robust variance was used to estimate the incidence rate ratio (IRR) of brachytherapy utilization in each year category in reference to the 2004 – 2006 category. Additionally, risk factors for brachytherapy utilization were identified. ResultsOverall brachytherapy utilization increased from 54.9% in 2004 to 75.7% in 2020. Compared to 2004 – 2006 when rates of utilization totaled 55.2%, brachytherapy utilization significantly increased to 63.4% in 2011 – 2014 (IRR: 1.15 95% CI: 1.11 – 1.19), 66.0% in 2015 – 2017 (1.20 [1.16 – 1.23]), and 76.0% in 2018 – 2020 (1.38 [1.34 – 1.42]). Sociodemographic factors associated with decreased brachytherapy utilization included Black race (0.94 [0.92 – 0.97]), Hispanic ethnicity (0.92 [0.90 – 0.95]), and age greater than 59 (age ≥ 60 – 69: 0.96 [0.94 – 0.98] ; age ≥ 70 – 79: 0.89 [0.87 – 0.92] ; age ≥ 80: 0.73 [0.69 – 0.77]) . Positive predictors of brachytherapy utilization included having insurance (IRR: 1.11, 95% CI: 1.07 – 1.14). ConclusionsIn patients with FIGO IB – IVA cervical cancer treated with radiation therapy from 2004 to 2020, brachytherapy utilization has increased over the past decade. These results are encouraging given the known benefit to cause-specific survival and overall survival provided by brachytherapy treatment, and indicate a reversal in the trend of declining brachytherapy noted previously. Concerns related to disparities by race, ethnicity and insurance status require further interventions.