Racial disparities in time to treatment initiation and survival outcomes in patients with vulvar cancer: a national cancer database analysis

Background Racial and ethnic disparities in gynecologic cancer care are well documented, yet inequities in treatment timeliness and outcomes for vulvar squamous cell carcinoma (VSCC) have not been examined in large national cohorts. Treatment delay is a potentially modifiable disparity, and the role of neighborhood socioeconomic status (nSES) in shaping racial and ethnic differences in care remains unclear. Methods We conducted a retrospective cohort study using the National Cancer Database of women aged ≥ 18 years diagnosed with FIGO stage I–IVA VSCC from 2004 to 2020. Race/ethnicity was categorized as non-Hispanic (NH) White, NH Black, Hispanic, and Asian/Pacific Islander. The primary outcome was treatment delay, defined as time to treatment initiation (TTI) > 30 days from diagnosis. Overall survival (OS) was secondary. Multivariable logistic and Cox regression models adjusted for demographic, clinical, socioeconomic, insurance, facility, and treatment factors. Interaction terms assessed whether nSES modified associations. Results Among 9,023 women, Hispanic patients had higher odds of treatment delay compared with NH White patients (aOR 1.31, 95% CI 1.03–1.67). No significant differences were observed for NH Black or Asian/Pacific Islander patients. nSES did not modify these associations (P = 0.44). Although NH Black patients had improved unadjusted OS, this difference was not significant after adjustment. Race/ethnicity was not independently associated with OS. Conclusions Hispanic women with VSCC experience persistent treatment delays not explained by socioeconomic or clinical factors. Efforts to reduce delays through culturally responsive interventions are needed to advance equity in vulvar cancer care.