Cervical cancer treatment delayed in Medicaid patients

Cervical cancer treatment delayed in Medicaid patients | Image Credit: © zimmytws - © zimmytws - stock.adobe.com.

Timely cervical cancer treatment is less likely among patients with Medicaid insurance, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Approximately 14,050 new US cervical cancer cases and 4290 cervical cancer deaths were reported in 2024.² While screening and human papillomavirus vaccination have been linked to significantly reduced risks, disproportionate morbidity and mortality rates have been identified in marginalized populations, requiring complex care.¹

“Thus, identifying risk factors for delayed time to treatment may help determine those in need of further assistance in this transitional period and identify mechanisms to improve quality of life and clinical outcomes in this high-risk population,” wrote investigators.

Assessing delays in treatment

The cohort study was conducted to identify risk factors of delayed cervical cancer treatment. Participants included patients aged at least 18 years and with a locally advanced cervical cancer diagnosis visiting the University of California, San Francisco for care between January 1, 2003, and September 30, 2023.

Exclusion criteria included insufficient follow-up records, initial cervical cancer not managed at USCF, active treatment during data abstraction, rare histology, and not receiving cancer-directed therapy. Timely initiation to treatment, defined as 60 days or less between diagnosis and treatment initiation, was reported as the primary outcome.

The first day of curative or palliative cancer-directed treatment indicated treatment initiation. Time from biopsy to staging and time from staging to treatment were reported as secondary outcomes. Age, race, insurance status, travel distance, Charlson Comorbidity Index (CCI), and social vulnerability index (SVI were included as demographic risk factors.

Insurance, social factors, and delayed treatment

There were 280 participants included in the final analysis, 37.1% of whom received timely initiation to treatment. Overall, a median duration of 68.5 days was reported between biopsy and treatment initiation. Of participants, 49.6% were White, while 30.4% did not self-report race, and an age of 40 to 49 years was reported in 31.4%.

Medicaid insurance was found in 75.4% of patients, private insurance in 17.1%, Medicare in 6.4%, and being uninsured in 1.1%. Additionally, 65.4% had stage 3 disease and 78.2% squamous cell carcinoma histology.

In those with timely treatment, 81.8% had Medicaid insurance vs 64.4% with delayed treatment. Rates of having no self-reported race were 36.9% and 19.2%, respectively, while rates of being in the third highest SVI quartile were 14.4% and 24.4%, respectively.

A significant increase in delayed treatment risk was identified in patients with Medicaid insurance, with an odds ratio (OR) of 2.76 vs private insurance. For being in the third highest quartile of SVI vs the first SVI quartile, the OR was 2.68, indicating a significant rise in risk.

Protective and risk factors identified

Delayed treatment was less likely in patients with stage 3 A-C cancer vs IB3-2B cancer, with an OR of 0.56. However, an increased risk with an OR of 2.62 was reported in patients with no self-reported race vs White patients, alongside an OR of 0.53 indicating decreased odds in non-Hispanic vs Hispanic patients.

Decreased odds of delayed treatment based on an OR of 0.19 were also found in patients aged at least 70 years vs those aged under 30 years. No significant associations were reported for CCI, travel time, or histology.

In a multivariate analysis, the odds of delayed treatment were increased 2.42-fold among patients with Medicaid vs private insurance, while significant associations were not observed for SVI and stage of disease. Overall, the data highlighted significant treatment delay for cervical cancer in Medicaid patients.

“Our findings emphasize the need for future studies to examine associations with clinical outcomes and identify meaningful interventions that target the referral and navigation process… to address social needs to reduce this inequity in delivery of care,” wrote investigators.

References

1. Liang J, Mvemba A, Swanson M, et al. Delay to timely treatment in locally advanced cervical cancer: insurance inequities in access to gynecologic oncology. Am J Obstet Gynecol. 2025;233:186.e1-9. doi:10.1016/j.ajog.2025.02.032
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820