Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study
A. Katz et al., Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study, INT J RAD O, 47(2), 2000, pp. 443-450
Citations number
19
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: To describe the relationship between socioeconomic variables and t
he treatment of patients with radiotherapy for cervix cancer.
Methods and Materials: Sixty-two institutions were randomly selected from a
list of all radiotherapy facilities in the United States. From these we ra
ndomly selected and reviewed 471 cases of squamous cell carcinoma treated d
uring 1992 to 1994. To create an additional minority-rich sample, we random
ly selected 215 additional cases from 17 randomly selected institutions tha
t admitted > 40% minority patients. The median household income of each pat
ient's neighborhood was determined by matching her zip code to data from th
e 1990 United States Census.
Results: Patients who lived in low-income neighborhoods, who had only Medic
aid coverage, or who were treated at large academic or minority-rich instit
utions tended to have a poorer initial performance status, higher-stage or
bulky central disease, and a lower pretreatment hemoglobin level. Ability t
o complete treatment did not correlate with ethnicity or income. However, n
oncompliant patients tended to be treated at minority-rich institutions and
were more often less than or equal to 40 or > 60 years old. Patients who c
ompleted definitive treatment were more likely to have had less than or equ
al to 1 low-dose-rate intracavitary implants if they were black, came from
a low-income neighborhood, were covered by Medicaid or Medicare only, or we
re treated at a minority-rich institution. Patients who were treated in aca
demic institutions received higher mean radiation doses to Point A (83.8 Gy
) than those treated in research- or non-research-participating facilities
(79.4 and 80.9 Gy, respectively; p = 0.002). Patients who received their ra
diation therapy in facilities that treated an average of less than or equal
to 3 patients per year also received lower mean doses to Point A (79.1 vs.
83.0 Gy; p = 0.001).
Conclusion: The treatment received by patients who belonged to minority gro
ups, came from low-income neighborhoods, or were treated in large, minority
-rich institutions differed in several respects from that of white, higher
income patients. Larger, more detailed studies will be needed to clarify th
e reasons for these differences and to define any influence on treatment ou
tcome. (C) 2000 Elsevier Science Inc.