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Original research
Disparities in time to start of definitive radiation treatment for patients with locally advanced cervical cancer
  1. Nikhil V Kotha1,
  2. Casey W Williamson1,
  3. Loren K Mell1,
  4. James D Murphy1,
  5. Elena Martinez2,
  6. Pratibha S Binder3 and
  7. Jyoti S Mayadev1
  1. 1 Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
  2. 2 University of California San Diego Moores Cancer Center, La Jolla, California, USA
  3. 3 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Jyoti S Mayadev, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92093, USA; jmayadev{at}ucsd.edu

Abstract

Background Chemoradiation or radiation therapy alone are curative standards for patients with locally advanced cervical cancer.

Objective To investigate factors that influence time to initiation of chemoradiation or radiation and the subsequent impact of time to treatment on recurrence and survival outcomes.

Methods Patients with locally advanced cervical cancer treated with definitive chemoradiation or radiation at our institution between November 2015 and August 2020 were retrospectively identified. Time to treatment initiation was defined as the number of days from date of diagnosis (via biopsy) to the start date of radiation. The cohort was stratified by the median time to treatment into early (<75 days) and delayed (≥75 days) cohorts. Multivariable logistic regression was conducted to examine factors associated with delayed time to treatment.

Results We identified 143 patients with locally advanced cervical cancer who underwent definitive chemoradiation or radiation. Median follow-up time was 18 months (range 2–62). A total of 71 (49.7%) patients had time to treatment <75 days and 72 (50.3%) patients had time to treatment ≥75 days. The delayed cohort had a higher proportion of Hispanic patients (51.4% vs 31.0%, p=0.04). In multivariable modeling, Hispanic women were 2.71 times more likely (p=0.04) to undergo delayed time to treatment than non-Hispanic white women. Additionally, patients with stage >IIB disease were less likely to undergo delayed time to treatment (OR 0.26, p=0.02) than patients with stage <IIB disease. There was no interaction between race/ethnicity and disease stage. Delayed time to treatment was not associated with inferior overall survival, loco-regional failure, or distant failure.

Conclusion Hispanic patients with locally advanced cervical cancer were more likely to receive delayed time to definitive treatment of ≥75 days. Further studies examining the presence of similar disparities in delay to definitive treatment for locally advanced cervical cancer at other institutions and settings are warranted.

  • Cervical Cancer
  • Radiation
  • COVID-19

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2021-003305

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    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Twitter @NikhilVKotha

    • Contributors The authors confirm contribution to the manuscript as follows. All authors had access to the data and approved the final version of the manuscript. NVK and CWW: conceptualization/design, data curation and formal analysis, writing – original draft, writing - review and editing. LKM, JDM, and EM: writing - review and editing, supervision. PSB and JSM: conceptualization/design, writing – review and editing, supervision. JSM: guarantor.

    • 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 LKM reports research grants from Merck; consultant fees from Bayer HealthCare; other fees from Merck, E.R. Squibb & Sons outside the submitted work. JDM serves as a consultant for The Boston Consulting Group; reports research grants from Agency for Healthcare Research and Quality, NIH outside the submitted work. JM serves as a consultant for Astra Zeneca, NRG Oncology, GOG Foundation, Varian Medical Systems; serves as co-chair for NRG Oncology Cervix Co-Chair; serves as board member for GOG Foundation outside the submitted work.

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