title: Factors associated with no surgery or radiation therapy for invasive cervical cancer in Black and White women.
abstract: This paper identifies the proportion of invasive cervical cancer cases that do not receive cancer-directed surgery or radiation; assesses the influence of race, stage, age, grade, nodal status, histology, and co-morbid cancer primaries on receipt of treatment; and considers reasons why cancer-directed therapy is not received. We analyzed data for 8,119 patients with invasive cervical cancer from eleven population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 1992-96. Approximately 8.03% of Whites and 11.64% of Blacks did not receive surgery or radiation therapy (no therapy). The percentage of cases receiving no therapy were greatest for unstaged cases, and for cases with unknown grade or unknown lymph node status. Adjusted odds of no therapy significantly increased with distant and unstaged disease (vs local stage) and older age (vs 0-39) at diagnosis; unknown grade (vs well differentiated); or unknown lymph node (vs no lymph node) status. Black cases were more likely to be unstaged and unstaged cases are more likely to not receive therapy. Blacks were more likely than Whites not to receive surgery because it was not recommended, contraindicated due to other conditions, or refused. Of cases refusing radiation, 53.85% of Whites and 83.33% of Blacks refused surgery, and of women refusing surgery, 22.58% of Whites and 50% of Blacks refused radiation. Stage, age, grade, and lymph node status directly influence receipt of treatment. Race influences receipt of treatment indirectly through stage. Reasons why therapy was not received (eg, not recommended, refused) differ according to race and stage at diagnosis.
authors.affiliation: Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, Utah 84602, USA. Ray_Merrill@byu.edu
authors.forename: R M
authors.initials: RM
authors.lastname: Merrill
authors.forename: A V
authors.initials: AV
authors.lastname: Merrill
authors.forename: L S
authors.initials: LS
authors.lastname: Mayer
mesh_terms: D001741:Black or African American; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D016312:Treatment Refusal; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D044465:White People