3560 - Neighborhood Socioeconomic Status of Women with Locally Advanced Cervical Cancer and Access to Brachytherapy

L. Rose¹, D. Handley², J. Plascak³, and A. M. Quick⁴; ¹Ohio State University College of Medicine, Columbus, OH, ²Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, ³Division of Cancer Prevention and Control at The Ohio State University, Columbus, OH, ⁴Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH

Purpose/Objective(s): We tested associations between neighborhood socioeconomic status (SES) and both the diagnosis of advanced stage cervical cancer and receipt of brachytherapy. Materials/

Methods: A retrospective chart review included patients diagnosed with cervical cancer treated at a Comprehensive Cancer Center between 2012 and 2022. Data collected included: age, race, ethnicity, residential address at diagnosis, diagnosis date, FIGO stage, histology, receipt of radiation, receipt of brachytherapy, receipt of surgery, vital status, and follow-up date. Patients with FIGO Stage II-IV were categorized as having locally advanced cervical cancer (LACC). Residential address was geocoded to 2010 census tracts. Census tract SES was estimated with annual, nationally percentiled Yost indices, and linked by patient address and year of diagnosis. Yost is a validated index created from education level, poverty status, household income, employment status, gross rent, home value, and occupation status for a given neighborhood. Yost scores of each patient were classified into quartiles, with quartile 1 (Q1) representing the lowest 15% SES, quartile 2 (Q2) representing 16-33% SES, quartile 3 (Q3) representing 34-55%, and quartile 4 (Q4) representing those in an SES above 55% of others in the United States.
Results: Results showed that after adjusting for demographics, patients in Q4 were less likely to be diagnosed with LACC compared to those in Q1 (p = 0.015). Those in Q4 had a 23% decreased risk of being diagnosed with LACC compared to Q1. Though not statistically significant, we saw a step-wise downward trend, where patients in Q4 had a lower risk of mortality compared to patients in Q1 during the first year following diagnosis (p =0.071). Furthermore, patients in Q4 also had a lower risk of cervical cancer-specific mortality compared to patients in Q1 in the first year following diagnosis (p =0.064). There was no significant relationship between Yost quartile and receipt of brachytherapy (p = 0.738). Patients who received brachytherapy had significantly increased survival in the first 60 months of diagnosis compared to those who did not receive brachytherapy (p <0.001).
Conclusion: Lower neighborhood SES was associated with LACC and poorer survival within the first 12 months of diagnosis. Interestingly, SES was not associated with receipt of brachytherapy; however, those who did receive brachytherapy had improved survival. Future studies should focus on identifying specific factors of SES that impact outcomes in patients with cervical cancer.