Trends in guideline-adherent chemoradiation therapy for locally advanced cervical cancer before and after the affordable care act

Authors

Rehema J. Thomas, The George Washington University, Division of Radiation Oncology, Washington DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington DC, United States of America.
Destie Provenzano, The George Washington University, Department of Biomedical Engineering, Washington DC, United States of America.
Sharad Goyal, The George Washington University, Division of Radiation Oncology, Washington DC, United States of America.
Murray Loew, The George Washington University, Department of Biomedical Engineering, Washington DC, United States of America.
Micael Lopez-Acevedo, Puerto Rico Women's and Children's Hospital, Bayamón, Puerto Rico.
Beverly Long, Sarasota Memorial Hospital, Sarasota, FL, United States of America.
Nicole P. Chappell, The George Washington University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington DC, United States of America.
Yuan James Rao, The George Washington University, Division of Radiation Oncology, Washington DC, United States of America. Electronic address: yrao@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

4-28-2022

Journal

Gynecologic oncology

DOI

10.1016/j.ygyno.2022.04.015

Keywords

Affordable care act (ACA); Cancer; Cervical cancer; Guideline-adherent Chemoradiation therapy (GA-CRT)

Abstract

OBJECTIVE: To assess trends in guideline-adherent chemoradiation therapy (GA-CRT) for locally advanced cervical cancer relative to Patient Protection and Affordable Care Act (ACA) implementation. METHODS: National Cancer Database patients treated with chemoradiation for locally advanced cervical cancer (FIGO 2018 Stage IB3-IVA) from 2004 to 2016 were included. GA-CRT was defined according to NCCN guidelines and included: 1) delivery of external beam radiation, 2) brachytherapy, and 3) chemotherapy, 4) no radical hysterectomy. Logistic regression was used to determine trends in GA-CRT relative to the ACA. Survival was also estimated using Kaplan-Meier analysis. RESULTS: 37,772 patients met inclusion criteria (Pre-ACA:16,169; Post-ACA:21,673). A total of 33,116 patients had squamous cell carcinoma and 4626 patients had other histologies. Forty-five percent of patients had lymph node-positive disease. A total of 14.6% of patients had Stage I disease, 41.8% had Stage II disease, 36.4% had Stage III disease, and 7.9% had Stage IVA disease. On multivariable analysis, medicare insurance (OR 0.91; 95%CI: 0.84-0.99 compared to commercial insurance), non-squamous histology (OR 0.83; 95%CI: 0.77-0.89 for adenocarcinoma) and increasing Charlson-Deyo score were associated with decreased odds of receiving GA care. Increasing T-stage was associated with greater receipt of GA-CRT. The percentage of the population that received guideline adherent care increased post-ACA (Pre-ACA 28%; Post-ACA 34%; p < 0.001). Adherence to treatment guidelines increased 2-year survival by 15% (GA 76%; Not GA 61%; p < 0.001). Increased 2-year survival was seen in the post-ACA cohort (Pre-ACA 62%; Post-ACA 69%; p < 0.001). CONCLUSIONS: Implementation of the ACA was associated with improved GA-CRT and survival in patients with locally advanced cervical cancer.

APA Citation

Thomas, Rehema J.; Provenzano, Destie; Goyal, Sharad; Loew, Murray; Lopez-Acevedo, Micael; Long, Beverly; Chappell, Nicole P.; and Rao, Yuan James, "Trends in guideline-adherent chemoradiation therapy for locally advanced cervical cancer before and after the affordable care act" (2022). GW Authored Works. Paper 735.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/735

Department

Radiology