Sociodemographic factors and delays in care for gestational trophoblastic neoplasia.

Abstract

e17617 Background: Delays in care are associated with worse outcomes for patients with the most common gynecologic cancers, however, there is a paucity of research about health care access and gestational trophoblastic neoplasia (GTN) outcomes. Methods: This was a retrospective cohort study at a single academic institution of patients with gestational trophoblastic neoplasia diagnosed between 2000-2025. Aspects of care and management of GTN were compared across racial, ethnic, insurance, and geographic cohorts. Continuous data were summarized using median and interquartile range, and comparisons between groups were made using Wilcoxon rank sum, Kruskal Wallis, or chi-square tests. Results: 71 patients were included in the study cohort. Patients with Medicaid, Medicare, or insurance assistance/TriCare were more likely to present to the ED as their site of first contact for GTN care (p=0.02). Non-white patients had a longer duration between first concern for GTN and initiation of GTN treatment (31 vs 13 days, p=0.01), however, Hispanic patients had fewer days between first contact with the health care system to initiation of GTN treatment (30 vs 55 days, p-0.04) and first imaging/labs concerning for GTN to treatment (10 vs 21 days, p=0.04). There were no differences in GTN care and management when comparing local to distant county of origin. Conclusions: Our findings suggest that disparities in access to care for GTN may exist for non-white patients and patients with Medicaid, Medicare, or insurance assistance/TriCare. Hispanic patients in this study moved more quickly through the health system to initiate GTN treatment. Given the importance of timely initiation of treatment for GTN to optimize cancer outcomes, interventions are needed to ensure that timely treatment of GTN is accessible to all patients. Characteristics of access to GTN care by race. Race Non-White(N=25) White(N=34) Total(N=59) P-value First Contact Location, n (%) 0.4743 1 OB Clinic 5 (25.0%) 10 (41.7%) 15 (34.1%) PCP clinic 3 (15.0%) 3 (12.5%) 6 (13.6%) ED 12 (60.0%) 10 (41.7%) 22 (50.0%) Other 0 (0.0%) 1 (4.2%) 1 (2.3%) Missing 5 10 15 Number of days from first labs/imaging concerning for GTN to treatment 0.0110 2 N 25 34 59 Median (IQR) 31.0 (15.0, 48.0) 13.0 (8.0, 28.0) 21.0 (9.0, 35.0) 1 Chi-Square p-value; 2 Wilcoxon rank sum p-value.