Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study

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.