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Healthcare access dimensions and uterine cancer survival: a national cancer database study

Mary Katherine Anastasio1, Anjali Gupta2,3, Tomi F Akinyemiju2

  • 1Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States.

Frontiers in Oncology
|October 23, 2023
PubMed

Insights

Black patients with advanced uterine cancer face significant survival disparities. Healthcare access, particularly affordability and availability, impacts outcomes, but further research is needed to address racial inequities in cancer care.

Area of Science:

  • Oncology
  • Health Services Research
  • Health Disparities

Background:

  • Racial disparities in uterine cancer diagnosis, treatment, and survival persist for Black patients.
  • Limited data exists on the impact of healthcare access (HCA) dimensions on advanced uterine cancer disparities.

Purpose of the Study:

  • To investigate how healthcare access dimensions influence disparities in survival for Black patients with advanced-stage uterine cancer.
  • To analyze the relationship between HCA factors and overall survival in non-Hispanic (NH)-Black, Hispanic, and NH-White patients with Stage III-IV uterine cancer.

Main Methods:

  • Utilized the National Cancer Database (NCDB) for patients aged 40-89 with Stage III-IV uterine cancer (2004-2015).
  • Assessed HCA affordability, availability, and accessibility using NCDB variables.
  • Employed Kaplan-Meier estimates, log-rank tests, and multivariable Cox proportional hazards models for survival analysis.

Main Results:

  • NH-Black patients were more likely to have advanced (Stage IV) and aggressive (Type II) disease.
  • NH-Black patients more frequently had government insurance, lived in low-income areas, and received chemotherapy only.
  • Private insurance and academic facility treatment predicted better survival; NH-Black patients had worse survival (HR 1.29) even after adjustments.

Conclusions:

  • HCA affordability and availability are survival predictors in advanced uterine cancer.
  • Racial disparities are compounded by more aggressive disease and less comprehensive treatment in NH-Black patients.
  • Exploring additional HCA dimensions is crucial for mitigating uterine cancer disparities.
Abstract

Keywords:
chemotherapyhealthcare accessracial disparitiesradiotherapyuterine cancer

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