Avoidable tragedies: Disparities in healthcare access among medically underserved women diagnosed with cervical cancer.
BACKGROUND
The purpose was to identify barriers including logistical and health belief correlates of late stage presentation of cervical cancer (CxCa) among medically underserved women presenting to a safety net health care system.


METHODS
Women presenting with newly diagnosed CxCa were asked to complete a detailed health belief survey that included questions about barriers to care and their knowledge of CxCa. All information was collected prior to initiating cancer treatment. Comparisons were made among women diagnosed at early stages of disease amendable to surgical treatment (≤IB1) and those diagnosed at a stage requiring local-regional or systemic/palliative treatment (≥IB2).


RESULTS
Among the 138 women, 21.7% were diagnosed with ≤lB1 disease, while 78.3% were diagnosed with ≥IB2 disease. Late-stage diagnosis was associated with a greater number of emergency room (ER) visits (p<.001) and blood transfusions (p<.001) prior to diagnosis. Compared to 88% with ≤lB1 disease, only 53% of patients with ≥IB2 disease had a car (p=.003). Women with ≥IB2 disease were more likely to be without a primary care provider (75.0% vs. 42.3%, p=.001).


CONCLUSIONS
Access to transportation and lack of a regular primary care provider or a medical home are associated with late-stage of CxCa at diagnosis. Many medically underserved women continue to use the ER as their primary source of health care, and as a result their CxCa is diagnosed in advanced stages, with higher medical costs and lower chances of cure. The lack of Medicaid expansion in Texas may result in a worsening of this situation.
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States. Electronic address: lramonde@mdanderson.org.
Lois M
LM
Ramondetta
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
Larissa A
LA
Meyer
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
Kathleen M
KM
Schmeler
Cervical Cancer Case Management, Harris Health System, Houston, TX 77054, United States.
Maria E
ME
Daheri
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
Jessica
J
Gallegos
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
Michael
M
Scheurer
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
Jane R
JR
Montealegre
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
Andrea
A
Milbourne
Departments of Obstetrics & Gynecology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, United States.
Matthew L
ML
Anderson
Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
Charlotte C
CC
Sun
D000328:Adult; D000368:Aged; D001336:Automobiles / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D057210:Delayed Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007389:Internal-External Control; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D064876:Safety-net Providers; D011795:Surveys and Questionnaires; D013781:Texas; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000473:pathology* / Q000523:psychology; D035862:Vulnerable Populations / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
Cervical cancer; Disparities; Emergency care; Insurance; Safety net