Declining brachytherapy utilization for cervical cancer patients - Have we reversed the trend?
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 reversed. The National Cancer Data...
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Published in | Gynecologic oncology Vol. 156; no. 3; pp. 583 - 590 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.03.2020
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Abstract | 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 reversed.
The National Cancer Database (NCDB) was queried for patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy between 2004 and 2014, identifying 17,442 patients. Brachytherapy utilization over time and by insurance type and other sociodemographic factors were compared using binary logistic regression. A sensitivity analysis was done in a sub-cohort of patients using the boost modality variable in the NCDB.
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 in all insurance groups (58.0%, OR 1.24, 95% CI 1.16–1.34) and was especially improved for Medicaid (OR 1.44, 95% CI 1.26–1.65) and uninsured patients (OR 1.28, 95% CI 1.03–1.57). Sensitivity analysis using the boost modality variable confirmed these trends.
In patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy from 2004 to 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 patient populations at-risk for future declines in brachytherapy use, proposed alternative payment models should incentivize cervical brachytherapy to solidify gains in brachytherapy utilization.
•Use of cervical brachytherapy (BT) declined in the late 2000s and disproportionately affected government-insured patients.•However, trends reversed in the early 2010s such that patients of all insurance types had increased BT use.•Awareness of declining BT use raised by researchers and the Affordable Care Act may have facilitated this improvement.•Proposed alternative payment models should incentivize cervical BT to encourage and solidify these gains. |
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AbstractList | 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 reversed.
The National Cancer Database (NCDB) was queried for patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy between 2004 and 2014, identifying 17,442 patients. Brachytherapy utilization over time and by insurance type and other sociodemographic factors were compared using binary logistic regression. A sensitivity analysis was done in a sub-cohort of patients using the boost modality variable in the NCDB.
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 in all insurance groups (58.0%, OR 1.24, 95% CI 1.16-1.34) and was especially improved for Medicaid (OR 1.44, 95% CI 1.26-1.65) and uninsured patients (OR 1.28, 95% CI 1.03-1.57). Sensitivity analysis using the boost modality variable confirmed these trends.
In patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy from 2004 to 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 patient populations at-risk for future declines in brachytherapy use, proposed alternative payment models should incentivize cervical brachytherapy to solidify gains in brachytherapy utilization. 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 reversed. The National Cancer Database (NCDB) was queried for patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy between 2004 and 2014, identifying 17,442 patients. Brachytherapy utilization over time and by insurance type and other sociodemographic factors were compared using binary logistic regression. A sensitivity analysis was done in a sub-cohort of patients using the boost modality variable in the NCDB. 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 in all insurance groups (58.0%, OR 1.24, 95% CI 1.16–1.34) and was especially improved for Medicaid (OR 1.44, 95% CI 1.26–1.65) and uninsured patients (OR 1.28, 95% CI 1.03–1.57). Sensitivity analysis using the boost modality variable confirmed these trends. In patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy from 2004 to 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 patient populations at-risk for future declines in brachytherapy use, proposed alternative payment models should incentivize cervical brachytherapy to solidify gains in brachytherapy utilization. •Use of cervical brachytherapy (BT) declined in the late 2000s and disproportionately affected government-insured patients.•However, trends reversed in the early 2010s such that patients of all insurance types had increased BT use.•Awareness of declining BT use raised by researchers and the Affordable Care Act may have facilitated this improvement.•Proposed alternative payment models should incentivize cervical BT to encourage and solidify these gains. OBJECTIVEStudies 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 reversed. METHODSThe National Cancer Database (NCDB) was queried for patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy between 2004 and 2014, identifying 17,442 patients. Brachytherapy utilization over time and by insurance type and other sociodemographic factors were compared using binary logistic regression. A sensitivity analysis was done in a sub-cohort of patients using the boost modality variable in the NCDB. RESULTSBrachytherapy 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 in all insurance groups (58.0%, OR 1.24, 95% CI 1.16-1.34) and was especially improved for Medicaid (OR 1.44, 95% CI 1.26-1.65) and uninsured patients (OR 1.28, 95% CI 1.03-1.57). Sensitivity analysis using the boost modality variable confirmed these trends. CONCLUSIONSIn patients with FIGO IIB-IVA cervical cancer treated with definitive chemoradiotherapy from 2004 to 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 patient populations at-risk for future declines in brachytherapy use, proposed alternative payment models should incentivize cervical brachytherapy to solidify gains in brachytherapy utilization. |
Author | Balasubramani, Goundappa K. Schad, Michael D. Vargo, John A. Glaser, Scott M. Patel, Ankur K. Beriwal, Sushil Showalter, Timothy N. |
Author_xml | – sequence: 1 givenname: Michael D. surname: Schad fullname: Schad, Michael D. organization: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America – sequence: 2 givenname: Ankur K. surname: Patel fullname: Patel, Ankur K. organization: Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America – sequence: 3 givenname: Scott M. surname: Glaser fullname: Glaser, Scott M. organization: Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States of America – sequence: 4 givenname: Goundappa K. surname: Balasubramani fullname: Balasubramani, Goundappa K. organization: Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America – sequence: 5 givenname: Timothy N. surname: Showalter fullname: Showalter, Timothy N. organization: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, United States of America – sequence: 6 givenname: Sushil surname: Beriwal fullname: Beriwal, Sushil organization: Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America – sequence: 7 givenname: John A. surname: Vargo fullname: Vargo, John A. email: vargoja4@upmc.edu organization: Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31924333$$D View this record in MEDLINE/PubMed |
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Keywords | Health insurance Brachytherapy Radiotherapy Cervical cancer |
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Snippet | Studies examining temporal trends in cervical brachytherapy use are conflicting and examined different health insurance populations. This study examined... OBJECTIVEStudies examining temporal trends in cervical brachytherapy use are conflicting and examined different health insurance populations. This study... |
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SubjectTerms | Brachytherapy Cervical cancer Health insurance Radiotherapy |
Title | Declining brachytherapy utilization for cervical cancer patients - Have we reversed the trend? |
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