eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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SCImago Journal & Country Rank

6/2021
vol. 13
 
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abstract:
Original paper

Brachytherapy utilization for cervical cancer in Western United States border counties: seeking to understand referral patterns for outcome improvement

Christine H. Feng
1
,
Corinne McDaniels-Davidson
2
,
Maria Elena Martinez
3
,
Jesse Nodora
4
,
Arno J. Mundt
1
,
Jyoti S. Mayadev
1

1.
UC San Diego School of Medicine, Department of Radiation Medicine and Applied Sciences, La Jolla, CA, USA
2.
San Diego State University School of Public Health, Institute for Public Health, San Diego, CA, USA
3.
UC San Diego School of Medicine, Moores Cancer Center Population Science, La Jolla, CA, USA
4.
UC San Diego Herbert Wertheim School of Public Health and Longevity Science, La Jolla, CA, USA
J Contemp Brachytherapy 2021; 13, 6: 620–626
Online publish date: 2021/12/30
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Introduction
Standard of care for definitive treatment of locally advanced cervical cancer (LACC) is concurrent chemoradiation followed by a brachytherapy boost. Only 55.8% of women in the United States receive brachytherapy, with even lower proportions in San Diego and Imperial Counties. The purpose of this study was to investigate brachytherapy practice and referral patterns in Western United States border region.

Material and methods
A short survey was sent to 28 radiation oncologists in San Diego and Imperial Counties, who treat patients with gynecologic malignancies. Descriptive statistics were used for analysis.

Results
Seventeen (61%) physicians responded to the survey. All physicians reported some training in cervical cancer brachytherapy during residency, with median 6 months. Only two physicians reported personally treating all cervical cancer patients with brachytherapy; however, 92% of remaining physicians would recommend brachytherapy for patients if given time and access. The most common reason for referral (78%) was patients deemed to require hybrid or interstitial brachytherapy implants. Barriers to referral included patients’ preference, insurance status, their resources, or logistics. No changes were reported for brachytherapy practices during the COVID-19 pandemic, except the addition of pre-procedural testing for SARS-CoV-2. Ninety-two percent of physicians identified inadequate maintenance of skills as a barrier to performing brachytherapy, but 77% were not interested in additional training. External beam radiation therapy boosts were rarely recommended in case scenarios describing potentially curable patients.

Conclusions
The importance of brachytherapy is widely recognized for conferring a survival benefit, but barriers to implementation include inadequate training or maintenance of skills, and larger systematic issues related to reimbursement policy, social support, and financial hardship. As most established providers were uninterested in additional brachytherapy training, future approaches to improve patients’ access should be multidimensional and reflect the value of brachytherapy in definitive treatment of patients with LACC.

keywords:

brachytherapy, cervical cancer, survey, underutilization, referral pattern, barriers to care

 
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