Barriers to treatment for patients diagnosed with cervical cancer: A systematic review

OBJECTIVE: Previous reviews have described disparities in the treatment of patients diagnosed with gynecologic cancers; however, these reviews are not systematic in nature, and none have focused specifically on individuals diagnosed with cervical cancer, who disproportionately represent marginalized populations in the US. This systematic review synthesizes evidence on treatment-related outcomes and multilevel determinants of care among US patients with cervical cancer. METHODS: The protocol was registered with PROSPERO (CRD42023413020). We searched PubMed, Scopus, and CINAHL for studies published through May 2026. Eligible studies examined treatment related outcomes among patients diagnosed with cervical cancer in the US. We identified 25 articles that met our inclusion criteria. Treatment-related outcomes were categorized and determinants (i.e., explanatory variables) were mapped on to the socioecological model. RESULTS: Across 25 studies, 26 treatment-related outcomes were identified. Receipt of surgery, chemotherapy, and brachytherapy were the most frequently assessed outcomes. Key patient-level determinants included race/ethnicity, age, comorbidities, insurance, rurality, and distance to care. Minoritized populations, particularly Black, Hispanic, Native American, Pacific Islander, often experienced worse treatment outcomes. Older age was also a frequent barrier to treatment. Distance to care was inconsistently associated with treatment outcomes. Clinic-level determinants, such as care outside of large-volume facilities and academic medical centers, and contextual determinants, such as residing in a county with lower levels of income and education, were associated with worse treatment outcomes. CONCLUSIONS: Cervical cancer treatment in the United States is driven by multilevel determinants at the patient-, clinic-, and community-level. Addressing barriers to treatment requires attention to the broader structural and modifiable factors that hinder treatment for marginalized cervical cancer patients in vulnerable communities. Future studies should more rigorously and thoughtfully measure community-level and individual-level variables.