title: Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment.
abstract: To evaluate racial-ethnic disparities in guideline-based care in locally advanced cervical cancer and their relationship to hospital case volume.
  
  
  
  Using the National Cancer Database, we performed a retrospective cohort study of women diagnosed between 2004 and 2012 with locally advanced squamous or adenocarcinoma of the cervix undergoing definitive primary radiation therapy. The primary outcome was the race-ethnicity-based rates of adherence to the National Comprehensive Cancer Network guideline-based care. The secondary outcome was the effect of guideline-based care on overall survival. Multivariable models and propensity matching were used to compare the hospital risk-adjusted rates of guideline-based adherence and overall survival based on hospital case volume.
  
  
  
  The final cohort consisted of 16,195 patients. The rate of guideline-based care was 58.4% (95% confidence interval [CI] 57.4-59.4%) for non-Hispanic white, 53% (95% CI 51.4-54.9%) for non-Hispanic black, and 51.5% (95% CI 49.4-53.7%) for Hispanic women (P<.001). From 2004 to 2012, the rate of guideline-based care increased from 49.5% (95% CI 47.1-51.9%) to 59.1% (95% CI 56.9-61.2%) (Ptrend<.001). Based on a propensity score-matched analysis, patients receiving guideline-based care had a lower risk of mortality (adjusted hazard ratio 0.65, 95% CI 0.62-0.68). Compared with low-volume hospitals, the increase in adherence to guideline-based care in high-volume hospitals was 48-63% for non-Hispanic white, 47-53% for non-Hispanic black, and 41-54% for Hispanic women.
  
  
  
  Racial and ethnic disparities in the delivery of guideline-based care are the highest in high-volume hospitals. Guideline-based care in locally advanced cervical cancer is associated with improved survival.
authors.affiliation: Division of Gynecologic Oncology, the Institute for Healthcare Policy and Innovation, the Department of Radiation Oncology, and the Department of Diagnostic Radiology, University of Michigan, Ann Arbor, Michigan; the Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin; and the Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
authors.forename: Christina
authors.initials: C
authors.lastname: Chapman
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Spencer
authors.forename: Shruti
authors.initials: S
authors.lastname: Jolly
authors.forename: Kate
authors.initials: K
authors.lastname: Maturen
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Marcela G
authors.initials: MG
authors.lastname: delCarmen
authors.forename: Laurel W
authors.initials: LW
authors.lastname: Rice
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000532:radiotherapy; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000532:radiotherapy; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000532:radiotherapy*; D044465:White People / Q000706:statistics & numerical data