Saris Daniel H, Pena Daniella, Haggerty Ashley F, Taunk Neil K, Ko Emily M, Smith Anna Jo Bodurtha
Pennsylvania Hospital, University of Pennsylvania Health System, Department of Obstetrics and Gynecology, Philadelphia, PA, United States.
Cornell University, Ithaca, NY, United States.
Gynecol Oncol Rep. 2023 Apr 3;47:101177. doi: 10.1016/j.gore.2023.101177. eCollection 2023 Jun.
Delays in starting potentially curative treatment for locally-advanced cervical cancer (LACC) decrease survival. Reasons for these delays are poorly understood. We conducted a retrospective chart review examining disparities in time from diagnosis of LACC to first clinic visit and to initiation of treatment based on insurance status within a single health system. We analyzed time to treatment using multivariate regression, adjusted for race, age, and insurance status. 25% of patients had Medicaid and 53% had private insurance. Having Medicaid was associated with delayed time from diagnosis to seeing a radiation oncologist (Mean 76.9 v. 31.3 days, p = 0.03). However, time from first radiation oncology visit to starting radiation was not delayed (Mean 22.6 v. 22.2 days, p = 0.67). Patients with locally-advanced cervical cancer and Medicaid had over double the time from pathologic diagnosis of cervical cancer to seeing radiation oncology; insurance disparities were not observed in treatment start after seeing radiation oncology. Improved referral and navigation processes for patients with Medicaid are needed to improve timely receipt of radiation and potentially improve survival.
局部晚期宫颈癌（LACC）启动潜在治愈性治疗的延迟会降低生存率。这些延迟的原因尚不清楚。我们进行了一项回顾性病历审查，研究了在单一医疗系统内，从LACC诊断到首次门诊就诊以及根据保险状况开始治疗的时间差异。我们使用多变量回归分析了治疗时间，并对种族、年龄和保险状况进行了调整。25%的患者有医疗补助，53%的患者有私人保险。拥有医疗补助与从诊断到看放射肿瘤学家的时间延迟有关（平均76.9天对31.3天，p = 0.03）。然而，从首次看放射肿瘤学家到开始放疗的时间没有延迟（平均22.6天对22.2天，p = 0.67）。患有局部晚期宫颈癌且有医疗补助的患者从宫颈癌病理诊断到看放射肿瘤学家的时间延长了一倍多；在看放射肿瘤学家后开始治疗时未观察到保险差异。需要改善针对有医疗补助患者的转诊和导航流程，以提高放疗的及时接受率，并有可能提高生存率。
