Declining brachytherapy utilization for cervical cancer patients - have we reversed the trend?
OC-0013
Abstract
Declining brachytherapy utilization for cervical cancer patients - have we reversed the trend?
Authors: Michael D. Schad1, Ankur K. Patel2, Scott M. Glaser3, Groundappa K. Balasubramani4, Timothy N. Showalter5, Sushil Beriwal2, John A. Vargo2
1University of Pittsburgh, School of Medicine, Pittsburgh, USA; 2UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Department of Radiation Oncology, Pittsburgh, USA; 3City of Hope Medical Center, Department of Radiation Oncology, Duarte, USA; 4Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, USA; 5University of Virginia School of Medicine, Department of Radiation Oncology, Charlottesville, USA
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Purpose or Objective
Studies examining temporal trends in cervical brachytherapy use are conflicting and examined different health insurance populations. This study examined brachytherapy utilization over time by health insurance type and whether reported declines in brachytherapy have been reversed.
Material and Methods
The National Cancer Database (NCDB) was queried for patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy between 2004-2014, identifying 17,442 patients. Brachytherapy utilization over time and by insurance type and other sociodemographic factors were compared using binary logistic regression. A secondary sensitivity analysis was done in a sub-cohort of patients using the boost modality variable in the NCDB.
Results
Brachytherapy utilization declined during 2008-10 (52.6%) compared to 2004-2007 (54.4%; Odds Ratio [OR] 0.93, 95% confidence interval [CI] 0.86-1.01) and declines were disproportionately larger for patients with government insurance (49.4% vs 52.3%, respectively) than privately-insured patients (57.6% vs 58.9%, respectively). However, rates of brachytherapy use subsequently recovered during 2011-14 (58.0%, OR 1.16, 95% CI 1.08-1.24, p<0.001) and was seen in all insurance groups including Medicare (OR 1.07, 95% CI 0.92-1.26), Medicaid (OR 1.25, 95% CI 1.09-1.44), and uninsured patients (OR 1.36, 95% CI 1.12-1.65). In patients with Medicare, rates of brachytherapy utilization in 2004-2007, 2008-2010, 2011-2014 were 50.0%, 47.6%, and 51.8%, respectively. A secondary analysis using the boost modality variable confirmed these trends.
Conclusion
In patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy from 2004-2014, brachytherapy utilization declined during the late 2000s and disproportionately affected patients with government insurance, but subsequently recovered in the early 2010s. Since government insurance covers vulnerable patients at-risk for future declines in brachytherapy use, proposed alternative payment models should incentivize cervical brachytherapy to solidify gains in brachytherapy utilization.