Liang Jessica, Mvemba Audrey, Swanson Megan, Hsu I-Chow Joe, Alvarez Edwin, Chapman Jocelyn, Fuh Katherine, Chen Lee-May, Cham Stephanie
School of Medicine, University of California San Francisco, San Francisco, CA.
Department of Obstetrics and Gynecology, Oakland, CA.
Am J Obstet Gynecol. 2025 Sep;233(3):186.e1-186.e9. doi: 10.1016/j.ajog.2025.02.032. Epub 2025 Feb 20.
Cervical cancer continues to disproportionately affect marginalized populations, with significant disparities in treatment and outcomes. Social determinants of health and insurance status have been associated with delays in treatment initiation, which can adversely affect clinical outcomes.
To determine the risk factors associated with delays in treatment initiation among patients with locally advanced cervical cancer and identify the time period of delay in treatment initiation.
We conducted a retrospective cohort study of patients with locally advanced cervical cancer at a single institution between 2003 and 2023. The primary outcome was timely initiation of treatment, defined as treatment initiation within 60 days of diagnosis by biopsy. Multivariate analysis was used to assess the impact of insurance status and other demographic factors on treatment delays.
Two hundred eighty patients were identified. The median time from biopsy to treatment initiation was 68.5 days (interquartile range, 52-104); 37.1% of patients received timely treatment initiation. Univariate analyses indicated patients with Medicaid had significantly increased odds of delayed treatment (odds ratio 2.76, 95% confidence interval 1.46-5.23) and living in a geographic location with a higher social vulnerability index (quartile 3 odds ratio 2.68 95% confidence interval 1.22-5.85). Multivariate analysis indicated that Medicaid was independently associated with delayed treatment compared to private insurance (odds ratio 2.42, 95% confidence interval 1.18-4.93). When time to treatment was stratified by time from biopsy to staging and time from staging to treatment start, delay was primarily attributable to time from biopsy to staging. In patients within the upper quartile of delay (>104 days), social risk factors including insurance-related issues and unmet social needs (eg, psychosocial distress, unstable housing, substance abuse) were identified as contributors to significant delays.
CONCLUSION(S): Medicaid insurance was independently associated with lower odds of timely cervical cancer treatment, driven largely by delays between biopsy and staging. These findings underscore the need for targeted interventions to address insurance-mediated barriers to initiation of care, which may include screening and addressing unmet health-related social needs and social risks.
宫颈癌对边缘化人群的影响仍然不成比例，在治疗和预后方面存在显著差异。健康的社会决定因素和保险状况与治疗开始延迟有关，这可能对临床结果产生不利影响。
确定局部晚期宫颈癌患者治疗开始延迟的相关危险因素，并确定治疗开始延迟的时间段。
我们对2003年至2023年期间在一家机构接受治疗的局部晚期宫颈癌患者进行了一项回顾性队列研究。主要结局是及时开始治疗，定义为在活检确诊后60天内开始治疗。采用多变量分析评估保险状况和其他人口统计学因素对治疗延迟的影响。
共纳入280例患者。从活检到开始治疗的中位时间为68.5天（四分位间距，52-104天）；37.1%的患者及时开始治疗。单变量分析表明，医疗补助患者治疗延迟的几率显著增加（比值比2.76，95%置信区间1.46-5.23），且居住在社会脆弱性指数较高地区的患者也是如此（四分位数3的比值比2.68，95%置信区间1.22-5.85）。多变量分析表明，与私人保险相比，医疗补助与治疗延迟独立相关（比值比2.42，95%置信区间1.18-4.93）。当按从活检到分期的时间以及从分期到开始治疗的时间对治疗时间进行分层时，延迟主要归因于从活检到分期的时间。在延迟时间处于上四分位数（>104天）的患者中，包括保险相关问题和未满足的社会需求（如心理社会困扰、住房不稳定、药物滥用）在内的社会风险因素被确定为显著延迟的促成因素。
医疗补助保险与宫颈癌及时治疗的几率较低独立相关，这在很大程度上是由活检和分期之间的延迟导致的。这些发现强调了需要采取有针对性的干预措施来解决保险介导的就医障碍，这可能包括筛查和解决未满足的与健康相关的社会需求及社会风险。
