title: Advanced cervical cancer treatment in Harris County: pilot evaluation of factors that prevent optimal therapy.
abstract: OBJECTIVE
  To document obstacles to completing outpatient treatment faced by indigent patients with cervical cancer and compare treatment costs.
  
  
  METHODS
  A retrospective pilot case series study assessed all indigent Harris County residents referred from Lyndon Baines Johnson Hospital (LBJ) to The University of Texas M. D. Anderson Cancer Center (M. D. Anderson) for advanced cervical cancer treatment between February 2001 and April 2004. Twenty-seven patients required hospital admission during the expected course of outpatient treatment and were identified as the study group. Nine patients, drawn from the same cohort but able to successfully complete the expected course of treatment as outpatients, were selected as the control group.
  
  
  RESULTS
  The median total treatment costs per patient in the study group (n = 27) was 28,892 US dollar more than the median treatment costs for the patients in the control group (n = 9) (P = 0.01). Median number of inpatient days in the study group was 19.6. Social factors identified as significantly different between the study and control groups included transportation difficulties (P = 0.006) and lack of social support (P = 0.08). Additional factors identified in the study group may have social significance such as accessible local housing (11% vs. 0%, P = 0.56) and noncompliance with treatment (37% vs. 11%, P = 0.22).
  
  
  CONCLUSIONS
  A combination of the lack of adequate methods of transportation and social support may contribute to the high cost of treating indigent patients with cervical cancer in Harris County, Texas.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Lyndon Baines Johnson General Hospital, Houston, TX 77230, USA. lramonde@mdanderson.org
authors.forename: Lois M
authors.initials: LM
authors.lastname: Ramondetta
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sun
authors.forename: Lisa
authors.initials: L
authors.lastname: Hollier
authors.forename: Latasha
authors.initials: L
authors.lastname: Jarrett
authors.forename: Jody
authors.initials: J
authors.lastname: Folloder
authors.forename: Guillermo
authors.initials: G
authors.lastname: Tortolero-Luna
authors.forename: Alycia
authors.initials: A
authors.lastname: Hughes
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Jubilee
authors.initials: J
authors.lastname: Brown
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D017057:Medically Uninsured; D008875:Middle Aged; D009367:Neoplasm Staging; D010045:Outpatients; D010349:Patient Compliance; D010865:Pilot Projects; D012189:Retrospective Studies; D012923:Social Class; D012944:Social Support; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology / Q000473:pathology / Q000532:radiotherapy*