Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study.
OBJECTIVE
To describe the relationship between socioeconomic variables and the treatment of patients with radiotherapy for cervix cancer.40% minority patients.


METHODS
Sixty-two institutions werw r andomly selected from a list of all radiotherapy facilities in the Unite d States. From these we randomly selected and reviewed 471 cases of squ amous cell carcinoma treated during 1992 to 1994. To create an addition al minority-rich sample, we randomly selected 215 additional cases from 17 randomly selected institutions that admitted >40% minority patients. The median household income of each patient's neighborhood was determined by matching her zip code to data from the 1990 United States Census.


RESULTS
Pati ents who lived in low-income neighborhoods, who had only Medicaid covera ge, or who were treated at large academic or minority-rich institutions tended to have a poorer initial performance status, higher-stage or bulk y central disease, and a lower pretreatment hemoglobin level. Ability t o complete treatment did not correlate with ethnicity or income. Howeve r, noncompliant patients tended to be treated at minority-rich instituti ons and were more often < 40 or > 60 years old. Patients who completed definitive treatment were more likely to have had </= 1 low-dose-rate intracavitary implants if they were black, came from a low-income neighborhood, were covered by Medicaid or Medicare only, or were treated at a minority-rich institution. Patients who were treated in academic institutions received higher mean radiation doses to Point A (83.8 Gy) than those treated in research- or non-research-participating facilities (79.4 and 80.9 Gy, respectively; p = 0.002). Patients who received their radiation therapy in facilities that treated an average of </= 3 patients per year also received lower mean doses to Point A (79.1 vs. 83.0 Gy; p = 0.001).


CONCLUSIONS
The treatment received by patients who belonged to minority groups, came from low-income neighborhoods, or were treated in large, minority-rich institutions differed in several respects from that of white, higher income patients. Larger, more detailed studies will be needed to clarify the reasons for these differences and to define any influence on treatment outcome.
Katz
A
A
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Eifel
P J
PJ
Moughan
J
J
Owen
J B
JB
Mahon
I
I
Hanks
G E
GE
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000208:ethnology / Q000532:radiotherapy*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D011897:Random Allocation; D012959:Socioeconomic Factors; D014481:United States; D014594:Uterine Neoplasms / Q000191:economics / Q000208:ethnology / Q000532:radiotherapy*