Disparities in Vulvar Cancer Reported by the National Cancer Database: Influence of Sociodemographic Factors.
OBJECTIVE
To assess whether there is an association of patient sociodemographic factors with stage at diagnosis, treatment, and overall survival in patients with vulvar cancer in the National Cancer Database.


METHODS
This was a retrospective cohort study of patients with primary squamous vulvar carcinoma identified from the National Cancer Database (1998-2004). Multivariate logistic regression was conducted to examine risk factors associated with advanced-stage (stage III or IV) disease at diagnosis. Multivariable Cox regression models were performed to explore risk factors associated with 5-year all-cause mortality.


RESULTS
Of 11,153 patients, 42.3% (n=4,713) were diagnosed with stage I disease, 24.6% (n=2,745) stage II, 22.9% (n=2,556) stage III, and 10.2% (n=1,139) stage IV. Advanced stage was significantly associated with older age, nonprivate insurance, and treatment at a lower case volume center (P<.01). Of note, roughly 30% of patients with advanced-stage disease did not receive radiation therapy. Within the advanced stages, age 60 years or older and insurance type were associated with decreased survival (P<.01). In stage III disease, only black race and treatment at a community hospital were associated with a lower risk of death (P<.01).


CONCLUSIONS
Patient sociodemographic and clinical characteristics are significantly associated with vulvar cancer stage presentation, treatment, and survival. Unfortunately, within this disease, surgical approaches and adjuvant radiation do not appear consistent.


METHODS
II.
Division of Gynecologic Oncology, University of Arizona Cancer Center, and the Department of Obstetrics and Gynecology, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, and the University of Arizona College of Public Health, Tucson, Arizona; and the Surveillance and Health Services Research Program, American Cancer Society, and the Department of Health Policy and Management, Emory University, Atlanta, Georgia.
Dana M
DM
Chase
Chun Chieh
CC
Lin
Christine D
CD
Craig
Stacey A
SA
Fedewa
Katherine S
KS
Virgo
John H
JH
Farley
Michael
M
Halpern
Bradley J
BJ
Monk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult