Despite better survival rates than in the past, nearly half of black and Hispanic women with locally advanced cervical cancer still don’t receive treatment that meets U.S. guidelines, which could help explain why they generally fare worse than white women with the same disease, according to a new report.
The study, “Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment,” appeared in Obstetrics & Gynecology. It analyzed records from 16,195 women treated between 2004 and 2012 for locally advanced cervical cancer, using data drawn from the National Cancer Database.
To identify which women had received guideline-informed care, the team looked at how doctors administered radiation therapy, as the National Comprehensive Cancer Network recommends radiation to be prescribed along with chemotherapy for cervical cancer.
In total, 57 percent of patients analyzed in the study had received appropriate, though disparities were evident among white women (58 percent), black women (53 percent) and Hispanic women (51 percent). Most surprisingly, researchers observed the largest gaps not in low-volume hospitals but in centers that saw many cervical cancer patients.
“It’s a common misconception,” Shitanshu Uppal, MBBS, study author and assistant professor at Michigan Medicine, said in a press release.
According to Uppal, research suggests high-volume centers help reduce disparities; however, treatment recommendations don’t necessarily improve with practice.
“It’s clear that the more surgeries you do, the better you get. But the ‘more is better’ mantra may not apply to guideline-concordant care,” he said. “These are facilities that know what to do and they’re doing it. But they’re not doing it consistently across all populations.”
Guideline-informed treatment seems to be increasing across all patient populations, although at a slower rate among black and Hispanic women. “Overall, it’s better for everyone. We’re closing the gap, but there’s still a gap. Even in 2012, we see a 5 percentage-point gap in guideline-based therapy,” Uppal added.
Study authors didn’t look into why these patients were not receiving adequate care. Younger women or those facing socioeconomic issues tend to be diagnosed more frequently with cervical cancer diagnoses more frequently. And that could influence a patient’s ability to finish treatment, suggests Uppal.
Uppal’s team now plans to interview patients individually to understand the reasons behind the disparity in treatment rates and which barriers might be at work in these cases.
Treatment will never be perfect, but for Uppal, aiming for rates around 75 percent would be a reasonable objective.
“Understanding the ‘why’ behind our findings is important, not just for minority populations but for all,” he said. “We can do better.”