Declining brachytherapy utilization for cervical cancer patients - Have we reversed the trend?

Schad, Michael D.; Patel, Ankur; Glaser, Scott; Balasubramani, Goundappa K.; Showalter, Timothy N.; Beriwal, Sushil; Vargo, John A.

doi:10.1016/j.ygyno.2019.12.032

Cited by 24 publications

(10 citation statements)

References 21 publications

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“…[54][55][56] Importantly, a recent NCDB analysis reported that BT rates have stabilized in recent years because of the implementation of the ACA and, in particular, positively affected patients with Medicaid or those who are uninsured. 57 Finally, aiming to build culturally competent cancer center, engaging minority community leaders, and encouraging minority physician recruitment in oncology can help breach significant cultural barriers, increase trust in medical providers, and expand access to necessary cancer services. [58][59][60] One important looming event that may further affect BT practice patterns is the upcoming implementation of the RO-APM.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities

Boyce-Fappiano

Nguyen

Gjyshi

et al. 2021

JCO Oncology Practice

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PURPOSE: Cervical cancer (CC) disproportionately affects minorities who have higher incidence and mortality rates. Standard of care for locally advanced CC involves a multimodality approach including brachytherapy (BT), which independently improves oncologic outcomes. Here, we examine the impact of insurance status and race on BT utilization with the SEER database. MATERIALS AND METHODS: In total, 7,266 patients with stage I-IV CC diagnosed from 2007 to 2015 were included. BT utilization, overall survival (OS), and disease-specific survival (DSS) were compared. RESULTS: Overall, 3,832 (52.7%) received combined external beam radiation therapy (EBRT) + BT, whereas 3,434 (47.3%) received EBRT alone. On multivariate logistic regression analysis, increasing age (OR, 0.98; 95% CI, 0.98 to 0.99; P < .001); Medicaid (OR, 0.80; 95% CI, 0.72 to 0.88; P < .001), uninsured (OR, 0.67; 95% CI, 0.56 to 0.80; P < .001), and unknown versus private insurance (OR, 0.61; 95% CI, 0.43 to 0.86; P < .001); Black (OR, 0.68; 95% CI, 0.60 to 0.77; P < .001) and unknown versus White race (OR, 0.30; 95% CI, 0.13 to 0.77; P = .047); and American Joint Committee on Cancer stage II (OR, 1.07; 95% CI, 0.93 to 1.24; P = .36), stage III (OR, 0.82; 95% CI, 0.71 to 0.94; P = .006), stage IV (OR, 0.30; 95% CI, 0.23 to 0.40; P < .001), and unknown stage versus stage I (OR, 0.36; 95% CI, 0.28 to 0.45; P < .001) were associated with decreased BT utilization. When comparing racial survival differences, the 5-year OS was 44.2% versus 50.9% ( P < .0001) and the 5-year DSS was 55.6% versus 60.5% ( P < .0001) for Black and White patients, respectively. Importantly, the racial survival disparities resolved when examining patients who received combined EBRT + BT, with the 5-year OS of 57.3% versus 58.5% ( P = .24) and the 5-year DSS of 66.3% versus 66.6% ( P = .53) for Black and White patients, respectively. CONCLUSION: This work demonstrates notable inequities in BT utilization for CC that particularly affects patients of lower insurance status and Black race, which translates into inferior oncologic outcomes. Importantly, the use of BT was able to overcome racial survival differences, thus highlighting its essential value.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities

Boyce-Fappiano

Nguyen

Gjyshi

et al. 2021

JCO Oncology Practice

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“…In the U.S., brachytherapy utilization declined during 2008–2010 compared to 2004–2007, and declines were larger for patients with government insurance than privately-insured patients. However, with the implementation of new policy in concert with researcher awareness, the brachytherapy utilization rate recovered during 2011–2014 in all insurance groups and was especially improved for Medicaid and uninsured patients [ 17 ]. Unlike the U.S., all patients are covered by government insurance in Korea.…”

Section: Discussionmentioning

confidence: 99%

Brachytherapy utilization rate and effect on survival in cervical cancer patients in Korea

et al. 2021

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Objective External beam radiation therapy (EBRT) with concurrent chemotherapy followed by intracavitary brachytherapy is the standard treatment in locally advanced cervical cancer. This study examined the brachytherapy utilization rate and evaluated the effect of brachytherapy on survival in cervical cancer patients in Korea. Methods In this study, data from the Korea Central Cancer Registry and Korean National Health Insurance Service and data on mortality from Statistics Korea were linked and used. Patients with other cancers, distant metastasis at diagnosis, or unknown stage or who underwent hysterectomy were excluded. A total of 12,721 cervical cancer patients were analyzed in this study. Results The brachytherapy utilization rate (%) was calculated as the proportion of patients who received brachytherapy among those who received curative EBRT. The brachytherapy utilization rate decreased from 84% in 2005 to 78% in 2013 (p<0.001). Brachytherapy utilization rates varied by region, ranging from 72% to 100% except for in Jeju Island, where the rate was 56%. The brachytherapy utilization rate was lower in patients older than 80 years; patients with localized disease, non-squamous cell carcinoma, or Charlson comorbidity index 3 or more; patients diagnosed after 2010; patients from certain regions; patients receiving medical aid; and patients who underwent gynecologic procedures. Multivariable Cox regression analysis showed that brachytherapy when added to curative EBRT was independently associated with better cancer-specific survival (CSS) and overall survival (OS) than curative EBRT only. Conclusion The brachytherapy utilization rate decreased from 2005 to 2013 and varied by region in Korea. Brachytherapy use is independently associated with significantly higher CSS and OS in cervical cancer.

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“…Advances in external RT with IMRT and image-guided radiation therapy have significantly reduced toxicities and improved outcomes. As a result, use of BT alone or as a boost has diminished over the last decades (21)(22). However, IMRT or stereotactic RT, although highly conformal, is not significantly better than BT in their ability to spare the surrounding previously irradiated tissues (4,19).…”

Section: Such Treatment Decisions Must Be Handled Only By Teamsmentioning

confidence: 99%

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

et al. 2021

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This study aimed to explore the current status and pattern of practice for reirradiation using brachytherapy (ReRT-BT) through a survey in Japan. MATERIALS AND METHODS:We distributed an e-mail-based questionnaire to 153 institutions equipped with high-dose-rate brachytherapy facilities. RESULTS: We received responses from 76 institutions (49.7%). Forty-three of these institutions performed ReRT-BT and 42 institutions (55%) performed ReRT-BT during 2009e2018. However, 29 of the 42 institutions (69%) reported difficulty in obtaining ReRT-BT case information from their respective databases. Almost all the institutions encountered insufficient database system to extract details about the ReRT-BT cases. Responses from 33 institutions included the number of ReRT-BT cases; this increased from 90 in the period 2009e2013 (institution median 5 0.5; 0e 16) to 172 in the period 2014e2018 (institution median 5 2; 0e26). Nine institutions had to perform ReRT-BT for more than one case per year. The major location for cancer treatment was the pelvis (94%), followed by the head and neck (5%) and others (1%). In six site-specific scenarios, barring uterine corpus cancer recurrence, more than 90% of radiation oncologists agreed to perform ReRT-BT, whereas other areas (head and neck, prostate, and rectal cancer) gained 16e37% agreement. CONCLUSIONS: This decade saw an increase in the number of ReRT-BT cases in Japan and radiation oncologists' interest in ReRT-BT as a viable therapeutic option. However, scarce availability, immature education system, and insufficient database system are barriers to further consensus building.

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Declining brachytherapy utilization for cervical cancer patients - Have we reversed the trend?

Cited by 24 publications

References 21 publications

Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities

Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities

Brachytherapy utilization rate and effect on survival in cervical cancer patients in Korea

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

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