SGO 2025: Exploring Geographic and Racial Disparities in Cervical Cancer Chemoradiation Initiation and Timing

Pharmacy Times interviewed Sophie Jabban, a medical student at NYU Grossman School of Medicine, on 2 studies she presented at the Society of Gynecological Oncology (SGO) Annual Meeting in Seattle, Washington. The posters were titled “Where You Live Matters: Geographic Disparities in Time to Chemoradiation Initiation for Cervical Cancer Patients by ZIP Code” and “Race and Ethnicity-Based Disparities in Chemoradiation Timing Among Cervical Cancer Patients.”

Sophie Jabban is a medical student at NYU Grossman School of Medicine in New York, New York.

In “Where You Live Matters: Geographic Disparities in Time to Chemoradiation Initiation for Cervical Cancer Patients by ZIP Code,” Jabban observed a trend toward longer delays in starting chemoradiation for cervical cancer patients in Brooklyn compared to Manhattan, though the difference was not statistically significant, likely due to a small sample size.

In “Race and Ethnicity-Based Disparities in Chemoradiation Timing Among Cervical Cancer Patients,”Jabban examined how race, ethnicity, and social determinants of health (SDOH) impact the timing of treatment initiation for cervical cancer. Jabban observed trends indicating that Black/African American and Hispanic/Latin patients experienced longer delays in starting chemoradiation compared to White patients. Although these differences were not statistically significant due to the limited sample size (110 patients), the median time from diagnosis to treatment was 22 days longer for Black/African American patients and 10 days longer for Hispanic/Latin patients. Despite these delays, once treatment began, all racial and ethnic groups completed chemoradiation within the recommended 56-day period, and there were no significant differences in the duration of treatment or chemotherapy regimens used across groups.

Jabban was able to identify key systemic barriers contributing to treatment delays, including limited access to primary or routine health care, which impacted early diagnosis and timely referrals to oncology. Patients with stronger health care access—more often White patients—were typically diagnosed through consistent gynecologic follow-up and quickly referred for treatment. In contrast, patients who accessed the health care system through emergency departments for symptoms like bleeding or pelvic pain often faced delays both in diagnosis and in navigating follow-up care.

Patient in undergoes MRI scan. Image Credit: © ihorvsn - stock.adobe.com

Insurance coverage also played a critical role; patients with Medicaid or no insurance experienced longer timelines to treatment initiation due to additional steps such as emergency Medicaid enrollment or longer approval times for imaging and procedures. Delays in pretreatment MRI imaging were found to be significantly longer for Black/African American and Hispanic/Latin patients, which may further contribute to treatment initiation delays.

Overall, Jabban explained that the study highlights how SDOH—such as insurance status, health care access, and referral pathways—can shape inequities in cancer care delivery and underscores the need for further research to address these systemic disparities.

Where You Live Matters: Geographic Disparities in Time to Chemoradiation Initiation for Cervical Cancer Patients by ZIP Code

Pharmacy Times: How do geographic disparities, as measured by ZIP code, impact the time to chemoradiation initiation for cervical cancer patients?

Sophie Jabban: Overall, we saw a trend towards longer timelines to chemoradiation for patients living in Brooklyn compared to Manhattan, though this was not statistically significant, which may have been limited by the sample size.

Pharmacy Times: What barriers (eg, pharmacy access, transportation, health care facility availability) contribute to delayed chemoradiation in certain geographic regions?

Jabban: This is something we are currently assessing with a prospective cohort study interviewing patients to assess facilitators and barriers to accessing cervical cancer care. Prior studies have shown that health facility availability and transportation are 2 major barriers associated with unequal access to care.

Race and Ethnicity-Based Disparities in Chemoradiation Timing Among Cervical Cancer Patients

Pharmacy Times: How do race and ethnicity influence delays in initiating chemoradiation for patients with cervical cancer?

HeLa cervical cancer cells. Image Credit: © heitipaves - stock.adobe.com

Jabban: Our study found that there were trends towards overall delays to initiating treatment among Black/African American and Hispanic/Latin patients compared to White patients with cervical cancer. We say trend because this study did not actually show statistically significant difference with our sample size of 110 patients, but we found that, overall, the median days from diagnosis to start of treatment was 22 and 10 days longer for Black/African American and Hispanic/Latin patients, respectively, compared to White patients.

This study also looked at time from start of chemoradiation to end of chemoradiation. Previous studies have identified that completion of radiation therapy within 56 days impacts cervical cancer outcomes, so we were curious to know whether race and ethnicity influence this timeline as well. We notably found no significant difference in days required for chemoradiotherapy (CRT), with all groups completing CRT under 56 days.

In terms of delays to overall initiation of CRT, we wanted to understand whether delays to pretreatment imaging might influence timing to treatment. We ultimately found that Black/African American and Hispanic/Latin patients took significantly longer than White patients to receive MRI after diagnosis. We hypothesized that these delays to imaging likely influence delays to overall treatment initiation, shedding some light into mechanisms for the different treatment journeys across racial and ethnic groups.

Pharmacy Times: What pharmacologic and systemic barriers contribute to disparities in chemoradiation timing among different racial and ethnic groups?

Jabban: There are numerous systemic barriers playing a role here, many of which we hope to further research to understand the most significant drivers behind disparities in the overall cancer care journey.

Access to primary/routine health care is a large systemic barrier. For many of the patients in our study with greater health care access, which involved a larger percentage of White patients, their cancers were frequently diagnosed through consistent Gyn follow-up and via pap smears—these patients relied on strong referral networks from their primary care providers to quickly access oncologists and initiate treatment. This differs from other patients who access their health care through emergency department (ED) visits. For these patients, initial presentation involved presenting to the ED for symptomatic malignancy (abnormal bleeding, pelvic pain)—these patients had both a delay to diagnosis and then a delay to accessing care because they were more easily lost to follow up after diagnosis and were less readily referred to oncology.

Access to insurance is also a key barrier. For many patients with Medicaid, we noticed longer timelines to chemoradiation compared to those who had private insurance. These patients either had no insurance prior to cancer diagnosis and required emergency Medicaid, adding an extra step to their treatment journeys, or Medicaid itself is associated with longer times to approval for imaging or treatment. This is something we hope to further investigate.

Pharmacy Times: Are there differences in chemotherapy regimen selection or dosing adjustments based on race and ethnicity, and how do these impact treatment outcomes?

Jabban: We did not find a difference in regimen or dosing across groups.

Pharmacy Times: What roles do SDOH (eg, insurance status, geographic location, access to specialty care) play in chemoradiation delays for patients with cervical cancer?

Jabban: SDOH can significantly impact the care journey. As mentioned above, for many patients we studied, a cervical cancer diagnosis was their first touch point with the health system in a long time—patients who presented to the ED with pain/abnormal bleeding found to have cancer on biopsy. This contributes to delays because as a result these patients need to be reintroduced into the health system, for some of them that means getting emergency Medicaid for treatment and establishing care with a hospital that offers oncology services.