Cervical cancer patient outcomes in a safety-net healthcare system.

Abstract

e17514 Background: Cervical cancer is largely a preventable cancer. Although cervical cancer rates are decreasing in the United States following the introduction of screening and vaccination, incidence remains high among Hispanic and Black populations. Once diagnosed with cancer, enrollment into clinical trials is disproportionately lower for these patient populations. Safety-net health systems disproportionately care for racial/ethnic minorities, positioning them as critical access points for improving clinical trial availability and enrollment . We aimed to characterize patient population with cervical cancer at a large safety-net health system in North Texas. Methods: We identified patients diagnosed with cervical cancer from 2012 to 2023 from JPS Tumor Registry, the institutional registry data of a Comprehensive Community Cancer Program within JPS Health Network and linked to their electronic health records. Kaplan Meier curve was used to assess the difference in survival time across cancer stages from an index date of diagnosis with censoring at date of last contact up to June 18, 2025. This study was approved by the North Texas institutional review board. Results: Our sample comprised of 386 women with a median age at diagnosis of 49 years, 27% were under 40 years. The majority (79%) were squamous cell carcinomas. Non-Hispanic White comprised 39%, Hispanics 37% and non-Hispanic Blacks 20%. Over half (57%) were uninsured, 21% had Medicare/Medicaid, 14% had private insurance, 7% had other coverage. 35% were positive for HPV whereas 41% were not tested. 70% tested negative for HIV, 28% were not tested and 2% tested positive for HIV infection. Stage breakdown is as follows: Stage 1: 123 (32%), 2: 76 (20%), 3: 95 (25%), 4A: 19 (5%), 4B: 60 (16%), only one patient was stage 0 and the remaining were unstaged. 73% of stage 1 patients underwent hysterectomy. 73% of stage 4B patients received systemic treatment. The overall 5-year survival for the cohort was 49% (95% CI: 44%, 55%). Overall survival at 5 years for stage 1 patients is 78% (95% CI: 70%, 87%) as compared to 9.7% (95% CI: 3.8%, 25%) of stage 4B. Conclusions: Despite a high proportion of racial/ethnic minorities, stage distribution of cervical cancer at our safety-net health system is similar to national reported statistics. National statistics report 68% relative survival at 5 years. Our median and stagewise survival is slightly lower than national statistics, this could be due to socio-economic reasons and comorbidities of the patient population seen in safety-net settings since a quarter of advanced stage patients did not receive systemic treatment. Access to necessary care to prevent cervical cancer and promote early detection will continue to be important. Availability of clinical trial options could improve outcomes for patients with advanced stage.