Addressing Barriers to Care: A Proposed Model to Predict Prolonged Treatment Time among Patients with Locally Advanced Cervical Cancer.

BACKGROUND:Completion of curative intent radiation for locally advanced cervical cancer (LACC) within 56 days is independently associated with improved outcomes. This study characterizes barriers to care among patients with LACC completing timely definitive treatment with external beam radiotherapy (EBRT) and brachytherapy (BT) boost. METHODS:Patients treated with curative intent radiation therapy from 2005-2021 at a tertiary care center were retrospectively reviewed, with patient and treatment characteristics being recorded. Multivariate risk analysis of clinical, sociodemographic, and geographic factors yielded a prognostic point-based "LACC-PRO" scoring system. RESULTS:325 patients with LACC treated with EBRT and BT were analyzed. Prolonged treatment time was associated with non-Hispanic ethnicity (p = 0.002), ECOG ≥ 1 (p < 0.001), current smoking (p = 0.002), lack of insurance coverage (p = 0.025), para-aortic nodal coverage (p = 0.015), lack of pre-BT imaging (p = 0.034), and non-primary site EBRT location (p = 0.005). Total scores on the predictive nomogram ranged from 0-18 (median 7). Among 140 patients with scores >7, 53.6% experienced prolonged treatment compared to 17.8% of the 185 patients with scores ≤7. CONCLUSIONS:Clinical and sociodemographic factors detrimentally impact timely completion of definitive radiation for LACC patients. A predictive nomogram may help identify patients at risk for prolonged treatment time. These results require validation in a larger cohort.