Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States

SIMPLE SUMMARY: Brachytherapy remains an essential part of the treatment paradigm for women diagnosed with cervical and endometrial cancers. Recent evidence suggests that treatment practice patterns are changing with decline in the use of brachytherapy for patients with cervical cancer. There has yet to be a national study of brachytherapy treatment practice patterns investigating existing disparities among all five of the United States’ federally recognized racial groups. The authors aim to identify racial differences among women with cervical and endometrial cancers among five federally defined United States race categories. Our findings unmasked that Native Hawaiian and other Pacific Islander women with endometrial cancer and Black women with cervical cancer are significantly less likely to receive brachytherapy treatment, particularly those at community cancer hospitals. ABSTRACT: Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA—non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.