title: Disparities in standard of care treatment and associated survival decrement in patients with locally advanced cervical cancer.
abstract: OBJECTIVE
  Standard of care (SOC) treatment for locally advanced cervical cancer includes pelvic external beam radiation (EBRT) with chemotherapy and interdigitated brachytherapy. We evaluated national utilization trends and factors associated with receiving SOC therapy.
  
  
  METHODS
  We utilized the National Cancer Database (NCDB) to identify women with locally advanced cervical cancer treated with definitive radiation or chemoradiation therapy and stratified these patients by treatment received.
  
  
  RESULTS
  We identified 15,194 patients. Only 44.3% of patients received SOC treatment and this group had significantly improved OS. High volume centers, academic centers, comprehensive community cancer centers, private insurance, and higher income, were all associated with an increased likelihood of receiving SOC, whereas Black patients were less likely to receive SOC. We found 26.8% of patients received no radiation boost, 23.8% received an EBRT boost only, and 49.5% of patients received EBRT with brachytherapy. Although an EBRT boost was advantageous over no boost at all (HR 0.720, p<0.001), OS was superior in patients who received brachytherapy (HR 0.554, p<0.001). Patients were more likely to receive no radiotherapy boost if they had lower incomes, Medicaid, were treated at low volume centers, or were treated at non-comprehensive community cancer centers.
  
  
  CONCLUSIONS
  SOC for locally advanced cervical cancer offers superior outcomes, yet less than half of patients receive SOC and there are disparities in which patients receive SOC treatment. No additional treatment, including sophisticated EBRT techniques including IMRT or SBRT, can make up for the survival decrement from lack of brachytherapy as a component of definitive care.
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, United States.
authors.forename: Tyler P
authors.initials: TP
authors.lastname: Robin
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, United States.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, United States.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Schefter
authors.affiliation: Department of Gynecologic Oncology, University of Colorado Cancer Center, Aurora, CO, United States.
authors.forename: Kian
authors.initials: K
authors.lastname: Behbakht
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, United States. Electronic address: christine.fisher@ucdenver.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Fisher
mesh_terms: D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D059039:Standard of Care; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy*
keywords: Brachytherapy; Cervical cancer; Chemoradiation; NCDB; Radiation