Conference proceeding
GSOR14 Presentation Time: 11:35 AM: Distribution of Centers Offering Brachytherapy Services for Patients with Cervical Cancer: A National Workforce Evaluation
Brachytherapy, v 21(6), pp S59-S60
Nov 2022
Abstract
Brachytherapy (BT) is an essential component of treatment for locally-advanced cervical cancers in conjunction with external beam radiation therapy (EBRT) and chemotherapy. Brachytherapy is a resource- and labor-intensive treatment not offered in all radiation facilities. Patients may be traveling great distances for treatment due to concentration of these resources.
The National Cancer Database (NCDB) was queried for adult women with cervical carcinomas treated with EBRT+BT from 2004-2018. Patients were dichotomized to those who received same-institution treatment (SIT) for EBRT + BT and those who had different-institution treatment (DIT), receiving BT in a reporting facility but not EBRT. Women treated with EBRT in a reporting facility but BT in a non-reporting facility were excluded due to lack of details on the BT-providing facility. One-way independent t-test and ANOVA were used to determine differences groups with respect to distance travelled. Chi-squared analysis was used to determine regional differences and patterns between academic/non-academic facilities.
A total of 44,684 women received chemoradiation across 1,236 facilities and 29,076 (65.1%) women received brachytherapy across 1,159 facilities. Of those, 23,513 (80.9%) received brachytherapy in 887 reporting facilities. SIT was delivered to 20,125 (85.6%) and 3,388 (14.4%) received only BT at a reporting facility (DIT). 5,563 received all treatment at non-reporting facilities after diagnosis. The rate of SIT treatment was relatively stable through the reporting period, fluctuating between 82.6% and 86.5% without a trend. The median number of BT cases over the time period per institution was 11 (IQR: 3-32). Academic centers had the highest total caseload per institution (median: 39 cases) with community cancer programs having the lowest (median: 2 cases), p<0.001). Only 14 centers (1.6%) treated ≥ 1 patient/month over the reporting period. Institutions in the top quartile for treatment volume treated 75.0% of all patients while the institutions in the middle quartile treated 22.7% and bottom quartile institutions treated 1.9% of patients (p<0.001). The median crow-fly distance for SIT vs DIT was 10.3 miles vs 33.4 miles (IQR: 4.7-25.4 vs 14.5-63.0 miles, p<0.001). 13.3% of women had to travel > 50 miles for brachytherapy, mostly in the Mountain and West North/South Central regions (p<0.001) and significantly more often for DIT (p<0.001). The median differential distance traveled for patients receiving DIT vs SIT was greatest in the West North Central (IA, KS, MN, MO, ND, NE, SD) at +42.3mi and East South Central (AL, KY, MS, TN) at +43.1mi. Similarly, the differential distance traveled for patients receiving DIT in an academic center was +33.2mi compared to +15.7mi for a comprehensive community program, +13.4mi in an integrated delivery network and +0.1mi for a community program (p<0.001).
The distribution of centers offering brachytherapy services for women with cervical cancers differs widely across the country with women in some regions traveling great distances to receive care at high-volume centers.
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Details
- Title
- GSOR14 Presentation Time: 11:35 AM: Distribution of Centers Offering Brachytherapy Services for Patients with Cervical Cancer: A National Workforce Evaluation
- Creators
- Zachary D. Horne - Allegheny Health NetworkSushil Beriwal - Allegheny Health NetworkTimothy N. Showalter - University of Virginia
- Publication Details
- Brachytherapy, v 21(6), pp S59-S60
- Publisher
- Elsevier
- Resource Type
- Conference proceeding
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Other Identifier
- 991021897267204721