Disparities In Healthcare: UFE Underutilized Among Women In Rural America
Alicia Armeli

Earlier this year, a large nationwide study investigating the treatment of uterine fibroids showed a startling healthcare disparity. Researchers at the University of Miami Leonard M. Miller School of Medicine found that uterine fibroid embolization (UFE), a minimally invasive, outpatient fibroid treatment performed by interventional radiologists, is underutilized in comparison to hysterectomy—especially in rural and smaller hospitals.1

“Even though UFE was introduced two decades ago, these findings suggest its awareness among patients and even our physician colleagues is very limited,” says Prasoon Mohan, MD, MRCS, Assistant Professor of Interventional Radiology at the University of Miami Leonard M. Miller School of Medicine and the study’s lead author.

Uterine fibroids are the most common noncancerous tumor in women of childbearing age.2 And although some women will never experience fibroid-related symptoms, many will seek treatment for heavy periods, pelvic pain and pressure, painful sexual intercourse, and incontinence.

Dr. Mohan and his team analyzed 2012-2013 data taken from the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient healthcare database in the US.1 By examining billing codes that indicated which treatment women received, the researchers discovered that more than 165,000 hysterectomies were performed than UFE (167,650 vs. 2,470). In rural hospitals, 9.4% of hysterectomies were performed in comparison to only 0.4% of UFE procedures. Moreover, 67.4% of UFE procedures were performed in large hospitals versus a staggering 7.9% performed in small hospitals.

According to the American Hospital Association, rural hospitals—which are typically smaller than urban hospitals—face unique barriers to quality care including long distances to diverse healthcare providers, modest budgets, and not enough doctors.3 These factors can leave rural and smaller hospitals vulnerable and unable to offer high-quality services that reflect current standards of care.3,4

And in some cases, patients who are candidates for minimally invasive procedures may not even be informed of all their options. “Not all patients who seek treatment for fibroids are informed about UFE,” Dr. Mohan explains. “A recent study found that 38% of women who received hysterectomy were not counseled about alternative treatments.”

When patient education is offered, research has shown it impacts an individual’s decision-making process. Multiple studies have suggested that patients who have access to informational tools regarding their options had more knowledge and understanding of their care—and were more likely to choose less invasive treatments.5

“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, such as Ask4UFE. Self-education by using these resources puts you in a better position to choose your treatment option.”

When seeking out treatment, it’s also important for patients to look for gynecologists who work collaboratively with interventional radiologists. “Specialties that work together toward complementary care can improve patient outcomes,” Dr. Mohan tells Ask4UFE. “In the past, interventional radiologists were utilized 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 addition to UFE awareness at the clinician-patient level, patient education must be a priority throughout the medical and scientific communities. Dr. Mohan notes that whether it’s at the national level with fibroid campaigns, more funding for fibroid research, or increased publicity to make this research known, there’s always room to improve UFE awareness—with the goal of reducing the number of hysterectomies.

Hysterectomy, or the surgical removal of the uterus, is a common treatment for fibroids. It’s so common that the majority of the 600,000 hysterectomies performed each year in the US alone are done to treat fibroids.6,7 Unlike hysterectomy, UFE is an outpatient procedure that only requires a small puncture in the upper thigh or wrist. By guiding a catheter to the uterine arteries, tiny embolic particles are released and block the vessels that lead to fibroids. Deprived of blood, fibroids soften and shrink, causing symptoms to subside. UFE has been found to have an approximate 90% cure rate.8

What’s more, Dr. Mohan and his team found UFE was linked to shorter hospital stays and to be less expensive than hysterectomy.1 “UFE is safe, effective, and minimally invasive. It lets women get back to work and normal life much quicker than surgery,” 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.”

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR   Prasoon Mohan, MD, MRCS, is an Assistant Professor of Interventional Radiology at the University of Miami Leonard M. Miller School of Medicine. Dr. Mohan’s clinical interests include arterial embolization, interventional oncology, and endovascular aortic aneurysm repair. In addition to his research, Dr. Mohan specializes in Vascular & Interventional Radiology and Diagnostic Radiology at the Sylvester Comprehensive Cancer Center in Miami, Fla.

REFERENCES

  1. S. 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.
  2. National Institutes of Health. (2017). Uterine Fibroids. Retrieved from https://medlineplus.gov/uterinefibroids.html
  3. American Hospital Association. (2011). Trendwatch: The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform. Retrieved from http://www.aha.org/research/reports/tw/11apr-tw-rural.pdf
  4. Rural Health Information Hub. (2015). Rural Hospitals. Retrieved from https://www.ruralhealthinfo.org/topics/hospitals
  5. 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.
  6. The American College of Obstetricians and Gynecologists. (2015). Frequently Asked Questions Special Procedures: Hysterectomy. Retreived from https://www.acog.org/Patients/FAQs/Hysterectomy
  7. Centers for Disease Control and Prevention. (2017). Data and Statistics: Hysterectomy. Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/index.htm
  8. McLucas, B., Voorhees, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, 25(1): 1-7.