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Factors Associated With Radiation Treatment Compliance for Women With Cervical Cancer in a Safety Net Health System
  1. Alfredo Echeverria, MD*,
  2. Haley Manley, BA,
  3. Barrett O'Donnell, BS,
  4. Joshua Asper, PA-C*,
  5. Mark Bonnen, MD* and
  6. Michelle Ludwig, MD, MPH, PhD*
  1. * Department of Radiation Oncology, Baylor College of Medicine, Houston, TX;
  2. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; and
  3. McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, TX.
  1. Address correspondence and reprint requests to Alfredo Echeverria, MD, Department of Radiation Oncology, Baylor College of Medicine, 1 Baylor Plaza, MS BCM 711 Houston, TX 77030. E-mail: echeverr{at}


Objective The aim of the study was to determine whether patient characteristics are associated with radiation treatment noncompliance.

Methods/Materials We retrospectively studied 244 patients with cervical cancer treated with chemoradiation between May 2006 and August 2015 at a safety net health center. Compliance with treatment was defined as missing less than 2 days of scheduled radiation.

Results Treatment records revealed a compliance rate of 50.8% in this population. Factors associated with noncompliance were younger age (hazard ratio [HR], 1.037; P = 0.004), presence of psychiatric diagnosis (HR, 0.581; P = 0.044), and having insurance (HR, 0.484; P = 0.022). Noncompliance was associated with a decrease in disease-free survival (HR, 0.555; P = 0.042) but was not associated with overall survival. International Federation of Gynecology and Obstetrics stage was associated with detriment in overall survival on multivariate analysis (HR, 2.034; P = 0.001).

Conclusions Younger patients, those with psychiatric illness, and those with insurance define a group that is more likely to be noncompliant with treatment and hence may require up-front intervention to improve outcomes.

  • Cervical carcinoma
  • Radiation therapy
  • Treatment compliance

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  • The authors declare no conflicts of interest.