Black and Hispanic women are less likely than white women to receive guideline-concordant endometrial cancer treatment

Kaspers, Mara; Llamocca, Elyse; Quick, Allison; Dholakia, Jhalak; Salani, Ritu; Felix, Ashley S.

doi:10.1016/j.ajog.2020.02.041

Cited by 51 publications

(49 citation statements)

References 46 publications

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“…Other studies have found similar percentages of adherence to NCCN guidelines, with rates ranging from 37% to 49% for pancreatic, 11 cervical, 17 ovarian, 10 and gynecologic cancers 12 . One study of invasive endometrioid endometrial cancers found 75% adherence to NCCN guidelines, 15 higher than we found in our sample. However, that study was consistent with our study in which women who received adherent treatment had better survival compared with those who received nonadherent treatment 15 .…”

Section: Discussioncontrasting

confidence: 85%

“…One study of invasive endometrioid endometrial cancers found 75% adherence to NCCN guidelines, 15 higher than we found in our sample. However, that study was consistent with our study in which women who received adherent treatment had better survival compared with those who received nonadherent treatment 15 . Overall, our findings align with past research among other cancers, showing that adherence to NCCN guidelines have survival benefits for endometrial cancer.…”

Section: Discussioncontrasting

confidence: 85%

“…Additionally, Black and NHPI women had worse survival compared with White women, whereas Asian women had improved survival compared with White women. The literature indicates that Black women are more likely to have an advanced stage at diagnosis and more aggressive tumors than other racial/ethnic groups, which could shape differences observed in overall survival 1,2,9,15,30,31,32,33 . Although our review of the literature did not identify any studies specific to NHPI women, few noted Asian/Pacific Islander women having higher grade tumors and less favorable histologic types compared with White women 15,33,34 .…”

Section: Discussionmentioning

confidence: 86%

“…The National Comprehensive Cancer Network (NCCN) has established evidenced‐based and consensus‐driven guidelines that have widely been adopted as the standard of care for various cancers 10‐14 . Adherence to NCCN guidelines has been cited in the literature to have a survival benefit for sites such as endometrial, 15 ovarian, 14,16 cervical, 17 pancreatic, 11 colorectal, 18 melanoma, 19 gastric, 13 and head and neck cancers 20 . These guidelines have also been viewed as a measure of quality of care and have shown improved cost effectiveness 21,22 .…”

Section: Introductionmentioning

confidence: 99%

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Guideline‐adherent treatment, sociodemographic disparities, and cause‐specific survival for endometrial carcinomas

Rodríguez

LeBrón

Chang

et al. 2021

Cancer

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BACKGROUND Adherence to National Comprehensive Cancer Network guidelines have been adopted as the standard of care for various cancers and have been cited to have survival benefits. Few studies have examined the association of adherent treatment and endometrial cancer survival among various racial/ethnic groups and socioeconomic statuses. METHODS Between January 1, 2006 and December 31, 2015, 83,673 women diagnosed with endometrial carcinomas were identified from the Surveillance, Epidemiology, and End Results database. Descriptive statistics of demographic and clinical characteristics were performed. Cox‐proportional hazards models were used to examine the effect on cause‐specific survival for adherence to guidelines across racial/ethnic and socioeconomic groups. RESULTS Within our sample, 59.5% were treated according to guidelines. Nonadherence to treatment guidelines was significantly associated with decreased survival compared with adherent care (adjusted hazard ratio [HR], 1.59; 95% CI, 1.52‐1.67). Being of Black (adjusted HR, 1.41; 95% CI, 1.32‐1.51) or Native Hawaiian/Pacific Islander (adjusted HR, 1.44; 95% CI, 1.19‐1.73) race/ethnicity compared with White women was significantly associated with worse survival. Being of Asian race/ethnicity (adjusted HR, 0.86, 95% CI, 0.78‐0.94) was significantly associated with improved survival compared with White women. Lower neighborhood socioeconomic status was associated with a negative effect on survival relative to women in the highest socioeconomic status category. CONCLUSIONS Findings from this study suggest treatment adherence is an independent predictor of improved survival; however, improved survival was not observed equally among all racial/ethnic and socioeconomic status groups. LAY SUMMARY The National Comprehensive Cancer Network (NCCN) has developed guidelines for physicians to follow in treating various cancers. Within this study of 83,673 women with endometrial cancer, 59.5% of women were treated according to the NCCN guidelines. The findings suggest following NCCN guidelines for treatment of endometrial cancer improves survival. Black or Native Hawaiian/Pacific Islander race and lower neighborhood socioeconomic status has worse survival rates compared with other groups, indicating the importance of exploring other factors that may shape treatment across racial/ethnic and socioeconomic status groups.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Guideline‐adherent treatment, sociodemographic disparities, and cause‐specific survival for endometrial carcinomas

Rodríguez

LeBrón

Chang

et al. 2021

Cancer

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“…Other studies have demonstrated the disparities of care which occur in ethnic minorities and the access and management given in gynecological pathology in the USA ( 7 , 8 , 9 ). Descriptive studies of AUB subtype distribution in a population in the USA have never been performed.…”

Section: Introductionmentioning

confidence: 99%

Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community

Sabre¹,

Serventi²,

Nuritdinova³

et al. 2021

J Turkish German Gynecol Assoc

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Objective: To describe the distribution of abnormal uterine bleeding (AUB) type according to the polyp (AUB-P); adenomyosis (AUB-A); leiomyoma (AUB-L); malignancy and hyperplasia (AUB-M); coagulopathy (AUB-C); ovulatory dysfunction (AUB-O); endometrial (AUB-E); iatrogenic (AUB-I); and not yet classified International Federation of Gynecology and Obstetrics classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. Material and Methods: We conducted a descriptive cross-sectional analysis at our outpatient women’s health clinic located in the Bronx, New York City, from November 2016 to December 2019. Results: Among 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age at diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median body mass index (BMI) was significantly higher in AUB-E (34.2 kg/m 2 , p=0.048) and AUB-O (32.6 kg/m 2 , p=0.038) compared to AUB-L (30 kg/m 2 ). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), and AUB-A (30.8%, p<0.001), had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more patients with diabetes mellitus (DM) than AUB-L (3.3%). Conclusion: In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and DM when compared to other types of AUB.

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Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype

et al. 2022

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IMPORTANCE Uterine cancer incidence has been increasing, particularly rates of aggressive, nonendometrioid subtypes, which are disproportionately higher among non-Hispanic Black women. The association of subtype-specific trends with uterine cancer mortality and with the role of tumor subtype and stage at diagnosis with racial disparities in uterine cancer deaths at the population-based level are not known.OBJECTIVE To estimate histologic subtype-and stage-specific uterine cancer mortality rates by race and ethnicity, corrected for hysterectomy. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used the US Surveillance, Epidemiology, and End Results-18 Incidence-Based Mortality database, representing approximately 26% of the US population and including deaths that occurred from 2000 to 2017. Hysterectomy correction was based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Uncorrected and corrected rates associated with uterine corpus cancer cases diagnosed between 2000 and 2017 and uterine corpus cancer deaths occurring between 2010 and 2017 were age-adjusted to the 2000 US standard population and are expressed per 100 000 person-years, and annual percent changes in rates were calculated using log-linear regression. Data analysis was performed from March 10 to May 20, 2021.EXPOSURES Tumor histologic subtype, cancer stage at diagnosis, and race and ethnicity.

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Black and Hispanic women are less likely than white women to receive guideline-concordant endometrial cancer treatment

Cited by 51 publications

References 46 publications

Guideline‐adherent treatment, sociodemographic disparities, and cause‐specific survival for endometrial carcinomas

Guideline‐adherent treatment, sociodemographic disparities, and cause‐specific survival for endometrial carcinomas

Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community

Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype

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