Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment

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Abstract

OBJECTIVE:

To evaluate racial–ethnic disparities in guideline-based care in locally advanced cervical cancer and their relationship to hospital case volume.

METHODS:

Using the National Cancer Database, we performed a retrospective cohort study of women diagnosed between 2004 and 2012 with locally advanced squamous or adenocarcinoma of the cervix undergoing definitive primary radiation therapy. The primary outcome was the race–ethnicity-based rates of adherence to the National Comprehensive Cancer Network guideline–based care. The secondary outcome was the effect of guideline-based care on overall survival. Multivariable models and propensity matching were used to compare the hospital risk-adjusted rates of guideline-based adherence and overall survival based on hospital case volume.

RESULTS:

The final cohort consisted of 16,195 patients. The rate of guideline-based care was 58.4% (95% confidence interval [CI] 57.4–59.4%) for non-Hispanic white, 53% (95% CI 51.4–54.9%) for non-Hispanic black, and 51.5% (95% CI 49.4–53.7%) for Hispanic women (P<.001). From 2004 to 2012, the rate of guideline-based care increased from 49.5% (95% CI 47.1–51.9%) to 59.1% (95% CI 56.9–61.2%) (Ptrend<.001). Based on a propensity score-matched analysis, patients receiving guideline-based care had a lower risk of mortality (adjusted hazard ratio 0.65, 95% CI 0.62–0.68). Compared with low-volume hospitals, the increase in adherence to guideline-based care in high-volume hospitals was 48–63% for non-Hispanic white, 47–53% for non-Hispanic black, and 41–54% for Hispanic women.

CONCLUSION:

Racial and ethnic disparities in the delivery of guideline-based care are the highest in high-volume hospitals. Guideline-based care in locally advanced cervical cancer is associated with improved survival.

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