Article Text

Download PDFPDF
External beam radiation and brachytherapy boost at different facilities is associated with increased treatment delays in cervical cancer
  1. Richard Li1,
  2. Elizabeth Germino1,
  3. Zachary D Horne2,
  4. John A Vargo3,
  5. Yi-Jen Chen1 and
  6. Scott Glaser1
  1. 1 Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
  2. 2 Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  3. 3 Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Scott Glaser, Radiation Oncology, City of Hope Medical Center, Duarte, CA 91010, USA; sglaser{at}


Introduction Due to variation in facility expertise and capabilities, patients commonly complete external beam radiation therapy at one facility and brachytherapy boost at another. We evaluated the association of external beam radiation therapy and brachytherapy at the same facility versus different facilities with treatment delays and survival.

Methods Patients receiving definitive external beam radiation therapy and brachytherapy for non-metastatic cervical cancer from 2004 to 2015 were identified in the National Cancer Database. Treatment delays were classified based on published thresholds: a course of >56 days was considered delayed, >65 days moderately delayed, and >77 days severely delayed. Fisher’s exact test and logistic regression were used to evaluate the association of same facility versus different facilities with treatment delays and predictors of same facility versus different facility treatment.

Results We identified 23 911 patients meeting the inclusion criteria at a median follow-up of 39.7 months (IQR 21.0–72.6 months), with 17 391 patients (72.7%) receiving same facility treatment and 6520 patients (27.3%) receiving different facility treatment. Any treatment delay was found in 49.3% of same facility treatments versus 51.9% of different facility treatments (p<0.001); moderate or worse delays in 24.8% of same facility versus 29.4% of different facility treatments (p<0.001); severe treatment delays in 11.3% of same facility versus 15.5% of different facility treatments (p<0.001). Receipt of same facility versus different facility treatment was independently associated with treatment delays (OR 1.28, 95% CI 1.20 to 1.37; p<0.001). Both treatment delays, particularly moderate delays (HR 1.20, 95% CI 1.13 to 1.28; p<0.001) and severe delays (HR 1.32, 95% CI 1.24 to 1.41; p<0.001), and different facility treatments (HR 1.11, 95% CI 1.06 to 1.16; p<0.001) were associated with worse survival.

Conclusions Delivery of external beam radiation therapy and brachytherapy at different facilities was associated with treatment delays and worse survival. Our findings underscore the importance of care coordination in cervical cancer management.

  • cervical cancer
  • brachytherapy
  • radiation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @hornezd

  • Contributors RL and SG conceived the study. RL performed the primary data analysis with oversight from SG. All authors contributed to the writing of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data from the National Cancer Database by the American College of Surgeons is used. Source code used for analysis is available upon request.