Healthcare access dimensions and uterine cancer survival: a national cancer database study

Mary Katherine Anastasio; Anjali Gupta; Tomi F Akinyemiju; Rebecca A Previs

doi:10.3389/fonc.2023.1263371

Healthcare access dimensions and uterine cancer survival: a national cancer database study

Front Oncol. 2023 Oct 5:13:1263371. doi: 10.3389/fonc.2023.1263371. eCollection 2023.

Authors

Mary Katherine Anastasio¹, Anjali Gupta^{2

3}, Tomi F Akinyemiju², Rebecca A Previs^{1

4

5}

Affiliations

¹ Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States.
² Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
³ Stanford University School of Medicine, Stanford, CA, United States.
⁴ Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC, United States.
⁵ Labcorp Oncology, Durham, NC, United States.

Abstract

Objective: Disparities exist throughout diagnosis, treatment, and survival for Black patients with uterine cancer. There is limited data on how several healthcare access (HCA) dimensions contribute to these disparities in patients with advanced stage uterine cancer.

Methods: Using the National Cancer Database (NCDB), we identified patients aged 40-89 years with Stage III-IV uterine cancer between 2004-2015 who received chemotherapy and/or radiotherapy. Race/ethnicity were classified as non-Hispanic (NH)-Black, Hispanic, and NH-White. Variables defined in the NCDB were used to assess HCA affordability, availability, and accessibility. Kaplan-Meier estimates, log-rank test, and multivariable Cox proportional hazards models were used to analyze overall survival.

Results: Of 43,134 patients, 78.8% of the cohort identified as NH-White, 15.3% NH-Black, and 5.9% Hispanic. NH-Black patients were the most likely to have type II (75.6% vs. 53.9% and 55.4%) and stage IV (40.8% vs. 30.7% and 32.3%) disease compared to NH-White and Hispanic patients. NH-Black patients were more likely than NH-White and Hispanic patients to have government funded insurance (58.6% vs. 50.3% and 50.4%), live in low-income areas (46.4% vs. 14.2% and 29.9%), and receive only chemotherapy (53.5% vs. 43.1% and 46.2%). Having private insurance and receiving treatment at an academic facility were positive predictors of survival. NH-Black patients had worse survival than NH-White patients after adjusting for clinical characteristics and healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34).

Conclusion: While HCA affordability and availability predicted survival in patients with advanced stage uterine cancer, additional factors contribute to racial disparities. Compared to NH-White patients, NH-Black patients had more aggressive disease, received only chemotherapy rather than combined therapy, and had worse survival regardless of cancer subtype. Additional dimensions of healthcare access must be explored to remedy uterine cancer disparities.

Keywords: chemotherapy; healthcare access; racial disparities; radiotherapy; uterine cancer.

Grants and funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.