The effect of transportation services on completion of radiation therapy for gynecologic malignancies.

Abstract

e13502 Background: Optimization of outcomes for gynecologic oncology patients undergoing radiation therapy (RT) depends on timely completion of treatment. Patients with poor access to transportation are at risk of protracted or incomplete treatment. We sought to characterize the impact of facility-provided transportation on completion of RT at our hybrid community-academic institution. Methods: This retrospective cohort included patients who underwent RT for gynecologic malignancies. Adjuvant vaginal brachytherapy for endometrial was excluded. The primary outcome was RT completion and duration of treatment. A multivariate analysis was conducted via a backward stepwise regression approach. Results: We identified 301 patients who met inclusion criteria including 14 with ovarian cancer (5%), 69 with cervical cancer (23%), 173 with uterine cancer (58%), 32 with vulvar cancer (11%), and 13 with vaginal cancer (4%). Most patients, 188 in total (62%), received adjuvant RT with curative intent, while 72 (24%) were treated primarily with RT, and the remaining 41 (14%) were treated palliatively. Whole pelvic RT (WPRT) was delivered to 141 patients (47%), 2 patients received brachytherapy (1%), and 158 patients (52%) were treated with a combination of modalities. Median duration of RT was 45 days (IQR 37-57). The median distance traveled was 8 miles (IQR 4.39-15.97). Transportation was provided for 51 patients (17%), while 250 (83%) transported themselves privately. The overall RT completion rate was 94% (n=283). Of patients for whom transportation was provided, 90% completed treatment (n=46), compared to 95% (n=237) of privately transported patients (p=0.21). For patients with cervical cancer undergoing primary chemoradiation (n=47), 68% (n=32) completed in less than 56 days. In a multivariate analysis of this cohort, the RR of completion of RT in 56 days or more based on transportation status was 2.16 (95% CI 0.48-9.78, p=0.32). Conclusions: RT completion rates were similar for those who received transportation (90%) compared to those with self-transport (95%). Furthermore, the overall cohort completion rate of 94% outperformed the historic rate of 83% 1 . Further research is needed to determine the association between transportation and completion, sociodemographic confounders, and other factors that potentially improved the completion rates in this cohort. Cham S, Li A, Rauh-Hain JA, et al. Association Between Neighborhood Socioeconomic Inequality and Cervical Cancer Incidence Rates in New York City. JAMA Oncology 2022;8(1):159–61. Multivariable relative risk regression analyzing the likelihood of completing RT at 56+ days in cervical cancer patients undergoing primary-curative RT (n=47). Factor RR 95% C.I. p-value BMI 0.93 0.86 1.01 0.07 Planned fractions 1.14 0.98 1.33 0.083 Transportation status Transportation provided (ref) Self-transport 2.16 0.48 9.78 0.315