The receipt of brachytherapy for locally advanced cervical cancer differed by race, with black women less likely to receive brachytherapy and more likely to have a shorter survival, a retrospective cohort study found. Recently published in Gynecologic Oncology, the findings suggest that brachytherapy may mediate survival outcomes for black women with cervical cancer.1
Using the National Cancer Database, the study researchers identified 16,116 women with stage IB2 to stage IVA cervical cancer who received treatment between 2004 and 2014. Only women who received external beam radiation therapy were included. Overall, 55.8% of the cohort population (8993 of 16,116 women) received brachytherapy boost, and 19.2% (3099 of 16,116 women) were black.
According to a multivariate analysis, black women with locally advanced cervical cancer had a 13% lower likelihood of receiving brachytherapy compared with non-black women (odds ratio [OR}, 0.87; 95% CI, 0.79–0.96; P =.007). And, black women who did receive brachytherapy had a lower likelihood of completing radiation therapy within the recommended timeframe compared with non-black women (43.5% vs 48.1%, respectively; P <.001)
In addition, a lower proportion of black women with locally advanced cervical cancer received a brachytherapy boost (50% vs 57%). Overall, black women lived a median of more than 1 year shorter (3.9 years; 95% CI, 3.6–4.6) compared with non-black women (5.2 years; 95% CI, 4.9–5.5; P <.001).
Survival differences between the groups, however, disappeared when black women and non-black women both received brachytherapy (hazard ratio, 1.04; 95% CI, 0.95–1.13; P =.42) and the interaction was statistically significant (P =.005).
“Black women with locally advanced cervical cancer are less likely to receive brachytherapy, which mediates survival differences by race,” the study authors wrote in conclusion. “Improving access to brachytherapy may improve overall survival.”
Alimena S, Yang DD, Melamed A, et al. Racial disparities in brachytherapy administration and survival in women with locally advanced cervical cancer [published online July 7, 2019]. Gynecol Oncol. doi: 10.1016/j.ygyno.2019.06.022