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Advanced cervical cancer treatment in Harris County: pilot evaluation of factors that prevent optimal therapy
Lois M Ramondetta1, Charlotte Sun, Lisa Hollier
1Department of Obstetrics and Gynecology, The University of Texas Lyndon Baines Johnson General Hospital, Houston, TX 77230, USA. lramonde@mdanderson.org
Insights
Indigent patients with cervical cancer face significant barriers to completing outpatient treatment. Lack of transportation and social support increases treatment costs for this vulnerable population.
Area of Science:
- Oncology
- Health Services Research
- Social Determinants of Health
Background:
- Indigent patients with advanced cervical cancer often encounter obstacles in completing outpatient treatment.
- Understanding these barriers is crucial for improving care and reducing healthcare costs.
Purpose of the Study:
- To identify challenges faced by indigent cervical cancer patients in completing outpatient treatment.
- To compare the treatment costs between patients who completed outpatient treatment and those who did not.
Main Methods:
- Retrospective pilot case series of indigent Harris County residents treated for advanced cervical cancer.
- Comparison of a study group (n=27) requiring hospitalization with a control group (n=9) completing outpatient treatment.
Main Results:
- The study group incurred median treatment costs $28,892 higher than the control group.
- Significant differences included transportation difficulties (P=0.006) and lack of social support (P=0.08).
- Higher inpatient days (19.6) were observed in the study group.
Conclusions:
- Inadequate transportation and social support contribute to increased treatment costs for indigent cervical cancer patients.
- Addressing these social determinants is vital for optimizing care and managing costs in this population.
Objective:
To document obstacles to completing outpatient treatment faced by indigent patients with cervical cancer and compare treatment costs.
Methods:
A retrospective pilot case series study assessed all indigent Harris County residents referred from Lyndon Baines Johnson Hospital (LBJ) to The University of Texas M. D. Anderson Cancer Center (M. D. Anderson) for advanced cervical cancer treatment between February 2001 and April 2004. Twenty-seven patients required hospital admission during the expected course of outpatient treatment and were identified as the study group. Nine patients, drawn from the same cohort but able to successfully complete the expected course of treatment as outpatients, were selected as the control group.
Results:
The median total treatment costs per patient in the study group (n = 27) was 28,892 US dollar more than the median treatment costs for the patients in the control group (n = 9) (P = 0.01). Median number of inpatient days in the study group was 19.6. Social factors identified as significantly different between the study and control groups included transportation difficulties (P = 0.006) and lack of social support (P = 0.08). Additional factors identified in the study group may have social significance such as accessible local housing (11% vs. 0%, P = 0.56) and noncompliance with treatment (37% vs. 11%, P = 0.22).
Conclusion:
A combination of the lack of adequate methods of transportation and social support may contribute to the high cost of treating indigent patients with cervical cancer in Harris County, Texas.
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