Geographical disparity in U.S. women’s healthcare
A study highlights the large disparity in recommendations and care among U.S. women, depending on where they live. The study, conducted by researchers at the University of Miami Leonard M. Miller School of Medicine, examined fibroid treatment procedures among women nationwide.
Hysterectomy vs. UFE benefits
The surgical removal of the uterus — hysterectomy — is used most commonly to treat fibroids. However, it requires a longer hospital stay, and is more expensive than UFE. Most significantly for many, it eliminates a woman’s option to bear children. Even ovary-sparing hysterectomies come with risks of earlier menopause.
On the other hand, UFE can preserve a woman’s fertility. The procedure is performed by an interventional radiologist. It is “safe, effective, and minimally invasive. It lets women get back to work and normal life much quicker than surgery,” say Dr. Prasoon Mohan, MD, MRCS. Dr. Mohan specializes in Vascular & Interventional Radiology and Diagnostic Radiology at the Sylvester Comprehensive Cancer Center in Miami, Fla. He is also Assistant Professor of Interventional Radiology at the University of Miami Leonard M. Miller School of Medicine and the author of the study.
Lower UFE rates in rural communities
Hysterectomies were used far more often than UFE, the findings conclude. In particular, hysterectomies were used disproportionately more at rural and small hospitals. “Even though UFE was introduced two decades ago, these findings suggest its awareness among patients and even our physician colleagues is very limited,” according to Dr. Mohan.
Dr. Mohan and his team focused their analysis on 2012-2013 data (specifically billing codes) from the largest all-payer inpatient healthcare database in the U.S., Nationwide Inpatient Sample (NIS). Only 2,470 UFE procedures were performed, in comparison to 167,650 hysterectomies, the data revealed.
In addition, findings showed that almost 10 percent of these hysterectomies were performed at rural hospitals while only .4 percent of UFE procedures were performed at these smaller institutions. In comparison, more than two-thirds of UFE procedures (67.4 percent) were performed at large hospitals, while 7.9 percent of UFE procedures were performed at small hospitals.
Lack of UFE knowledge
The reason that hysterectomies are still used more than UFE in rural and smaller hospitals might be due to the unique challenges facing these institutions. These challenges include long distances between health providers, smaller budgets, and inadequate numbers of doctors that leave smaller hospitals struggling to provide the most up to date care for their patients.
Another complication that can make it hard for women with symptoms of fibroids to access UFE is a lack of knowledge about the procedure. According to research, when patients are informed about all of their options they often choose less invasive treatment alternatives to address their health problems. Unfortunately, not all women who have symptoms of fibroids have access to all of their treatment options.5
“Not all patients who seek treatment for fibroids are informed about UFE.” A study found that 38% of women who received hysterectomy were not counseled about alternative treatments, Dr. Mohan explained.
“When a patient meets with a specialist, she should inquire about all options for treatment, including UFE, and ask whether she is a candidate for the procedure,” Dr. Mohan continues. “There’s also a lot of free quality information available on the Internet. Self-education by using these resources puts you in a better position to choose your treatment option.”
Collaborative care may be one solution
Women who are looking for treatments for uterine fibroids can be proactive. They should seek out gynecologists who collaborate with interventional radiologists equipped to perform UFE.
“Specialties that work together toward complementary care can improve patient outcomes,” Dr. Mohan says. In the past, doctors consulted interventional radiologists on a referral basis only. “This has been changing rapidly. Interventional radiology now acts as an independent specialty with direct access to patients and can collaborate with other specialties.”
In other words, patients must be educated and the medical and scientific communities must place an emphasis on this education. The hope is that improved patient awareness of UFE can lower hysterectomy rates.
Dr. Mohan says. “Because of its many patient benefits, it’s important that we continue to increase UFE awareness and find ways to make it more accessible to patients everywhere.”
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Sources for information referenced in this post
- Narayanan; A. Gonzalez; A. Echenique; P. Mohan. (2017). Nationwide analysis of hospital characteristics, demographics and cost of uterine fibroid embolization [Abstract 106]. University of Miami Miller School of Medicine, Miami, FL. SIR Annual Scientific Meeting, March 4–9, 2017.
- American Hospital Association. (2011).Retrieved from Trendwatch: The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform.
- Rural Health Information Hub. (2015). Retrieved from Rural Hospitals.
- Stacey, D., Bennett, C. L., Barry, M. J., et al. (2011). Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev, Oct; 5(10): CD001431.
- The American College of Obstetricians and Gynecologists. (2015). Retreived from Frequently Asked Questions Special Procedures: Hysterectomy.
- Centers for Disease Control and Prevention. (2017). Retrieved from Data and Statistics: Hysterectomy.
- McLucas, B., Voorhees, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, 25(1): 1-7.