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Risk Factors Identified for Detrimental Delays in Endometrial Cancer Surgery

Gina Columbus @ginacolumbusonc
Published: Friday, Sep 02, 2016

Emily M. Ko, MD

Emily M. Ko, MD

There are several risk factors—including geographical location, ethnicity, and health insurance status—that may lead to a surgical treatment delay in patients with endometrial cancer, explains Emily M. Ko, MD.

Survival analyses studied the demographics and socioeconomic status of patients with endometrial cancer who had a delay of undergoing surgery of more than 12 weeks from diagnosis. From the National Cancer Database, researchers studied factors of 88,256 patients with type 1 disease (defined as grade 1/2 endometroid histology) and 40,009 patients with type 2 disease (nonendometroid and grade 3 histology).1

Findings showed that age, African-American and Hispanic ethnicity, lack of Medicaid coverage, stage II/III disease, comorbidities, low-case volume at treating hospital, and eventual lymphadenectomy were significantly associated with delayed surgery for both type 1 and type 2 cancers. The surgical delay was also associated with a significant survival disadvantage at 5 years for type 1 cancers (86.6% vs 77.9%; P <.001) and type 2 cancers (67.9% vs 60.5%; P <.001).

In an interview with OncLive, Ko, an assistant professor of Obstetrics and Gynecology at the University of Pennsylvania, discusses the implications of these findings for patients with endometrial cancer.

OncLive: Please provide an overview of the study examining risk factors for surgical treatment delay in patients with endometrial cancer.

Ko: This was a study conducted in the National Cancer Database, and we wanted to look at patients with endometrial cancer, in particular. We do know that, or sometimes assume, that if patients have a delay of care, they perhaps might not do as well in the long run. Could we figure out or understand better who might have a delay of care? Additionally, what factors might be involved in that delay?

What were the reasons for delay of care?

That is a really good question. From the database, we took the information that was available and looked at where patients were treated, whether it was an academic center or community hospital setting. We looked at insurance status, basic demographics, racial differences, age, socioeconomic status, and we also looked at their medical baseline conditions. Taking all those factors into account, it was a sorting out process to see what were the key factors.

It looks like we did have to separate our patients into what we consider lower-risk patients with endometrial cancer versus higher-risk patients. Without diving too much into that, the factors that came out seemed to be related to age, African-American and Hispanic ethnicity, and some socioeconomic factors, including insurance status and coverage.

With these findings, is there a way to better care for these patients?

There definitely seems to be more work that needs to be done. It is not just a matter of why, for example, should race be a disparity. From an insurance status, why would that make a difference? Is it a matter of enough hospitals being available? Is it the daily logistics of getting an appointment? There are various factors that are underlying.

I do think there is room for improvement. It certainly is a global health system issue at a certain level, and down to the individual provider availability, as well.

How would you describe the treatment landscape for endometrial cancer?

Endometrial cancer is, in general, a fairly uniformly treated condition. Most patients tend to have surgery upfront as the first step in their treatment; there is a small fraction of patients who have an alternative form of treatment first, such as chemotherapy or radiation therapy rather than surgery. From the standpoint of a cancer, surgery is usually first.

There are other factors to consider, of course. Who is a good surgical candidate versus who has many risk factors and may not be a good candidate or might be at high risk for complications. Because most patients do undergo surgery first, we want to make sure that the mechanism to get there is really the most efficient and effective.

For now, surgery is the best treatment because most uterine and endometrial cancers are confined to the uterus, for the most part. For that reason, if you can get rid of the disease upfront, patients do well. There are subsets of the endometrial patient population who present differently; they have what we call higher-risk or higher-grade tumors. They may already have metastatic disease outside of the uterus. For those situations, we always think carefully whether surgery would be the best first step versus a nonsurgical option.

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