Assessing Multilevel Influences on Guideline-Concordant Care and Cervical Cancer Outcomes: The ACHIEVE Study

Columbia University Health Sciences, New York NY

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT No one should die from cervical cancer—a preventable disease. Up to 93% of invasive cervical cancer cases are preventable through established primary and secondary prevention strategies, yet over 4,300 females die from cervical cancer annually in the United States. Despite declining cervical cancer incidence over the past several decades, improved survival rates have not been observed across all groups. Black, Hispanic, Asian American/Pacific Islander, and Native American/Alaska Native females and those with low incomes are less likely to receive guideline-concordant cervical cancer treatment, which is associated with increased cervical cancer-specific mortality. Recent research, including ours, indicate a need to examine multilevel influences that impact treatment and survivorship outcomes. Our prior work (which demonstrates successful recruitment and follow-up of cancer cases through cancer registries, linkage with administrative datasets, and multi-modal data collection), and data from others show that healthcare system-level characteristics contribute to disparities in access to timely and high-quality care delivery across the cervical cancer care continuum. To address critical gaps in knowledge, the proposed study seeks to examine upstream indicators (including neighborhood poverty, limited availability of specialized care, fragmented care delivery, and spatial accessibility challenges) as contributors to disparities in receipt of guideline-concordant cervical cancer treatment and survival in a sample drawn from two population-based cancer registries. Guided by the NIMHD research framework, this mixed-methods study will leverage two National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program registries (New Jersey State Cancer Registry and Los Angeles Cancer Surveillance Program), to prospectively examine the impact of individual-, community-, and healthcare system-level factors on receipt of guideline-concordant treatment for and survival from cervical cancer. We will assemble a cohort of 960 females diagnosed with cervical cancer between 2021-2024 and obtain retrospective and prospective data (collected 12 months after baseline) from cancer registry records, self-reported questionnaires, medical records, and publicly available datasets to address these specific aims: 1.) Evaluate the association of sociodemographic and healthcare system factors on receipt of guideline-concordant treatment receipt for invasive cervical cancer, 2.) Evaluate the association of sociodemographic and healthcare system factors on cervical cancer outcomes, and 3.) Identify actionable strategies for addressing individual-, community-, and healthcare system-level challenges to optimize the delivery of high-quality cervical cancer care through one-on-one depth interviews with key stakeholders. This study will elucidate the multilevel causes of suboptimal cervical cancer treatment and poorer survival to develop actionable system-level practice and policy change to address the persistent disparities in cervical cancer outcomes.