title: Impact of payer status on treatment of cervical cancer at a tertiary referral center.
abstract: OBJECTIVE
  The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center.
  
  
  METHODS
  All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models.
  
  
  RESULTS
  A total of 306 patients were identified. Median age was 47 and 60% of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34% had public insurance, and 6% had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7% of privately insured and 4% of publicly insured patients did not receive definitive therapy, 16% of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p=0.027) than patients with public insurance.
  
  
  CONCLUSIONS
  In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. klevins1@jhmi.edu
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Levinson
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Donohue
authors.forename: Norma F
authors.initials: NF
authors.lastname: Kanarek
authors.forename: Cornelia L
authors.initials: CL
authors.lastname: Trimble
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D015999:Multivariate Analysis; D012017:Referral and Consultation; D012189:Retrospective Studies; D018426:SEER Program; D002583:Uterine Cervical Neoplasms / Q000628:therapy*