Disparities in cancer-specific and overall survival in black women with endometrial cancer: A Medicare-SEER study

Saris, Daniel; Smith, Anna Jo Bodurtha; Brensinger, Colleen M.; Kim, Sarah H.; Haggerty, Ashley; Latif, Nawar; Cory, Lori; Giuntoli, Robert L.; Morgan, Mark A.; Lin, Lilie L.; Ko, Emily

doi:10.1016/j.gore.2022.100922

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…When stratified by disease subtype, receipt of guideline‐concordant therapy in hospital‐based studies was lower among Black women than among White women for endometrioid subtypes, 183 but it was similar for nonendometrioid cancers 184,185 . However, population‐based studies of patients aged 65 years or older have reported that Black patients are more likely than White patients to have treatment delays and are less likely to receive adjuvant therapy regardless of histology 186,187 …”

Section: Selected Findingsmentioning

confidence: 99%

“…184,185 However, population-based studies of patients aged 65 years or older have reported that Black patients are more likely than White patients to have treatment delays and are less likely to receive adjuvant therapy regardless of histology. 186,187 Uterine corpus cancer is one of the few cancers for which survival has not substantially improved since the mid-1970s, reflecting few advances in treatment. However, more than two-thirds of patients with uterine corpus cancer are diagnosed at stage I (usually because of postmenopausal bleeding), for which the 5-year survival rate is 95%.…”

Section: Uterine Corpus (Endometrium)mentioning

confidence: 99%

See 1 more Smart Citation

Cancer treatment and survivorship statistics, 2022

Miller

Nogueira

Devasia

et al. 2022

CA A Cancer J Clinicians

1,850

1,089

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The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer.

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Section: Selected Findingsmentioning

confidence: 99%

Section: Uterine Corpus (Endometrium)mentioning

confidence: 99%

Cancer treatment and survivorship statistics, 2022

Miller

Nogueira

Devasia

et al. 2022

CA A Cancer J Clinicians

1,850

1,089

View full text Add to dashboard Cite

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“…Another significant finding of our study was the percentage associated with ERR in survival for histologic subtype. Other studies have shown the differences between histologic subtype, disease stage, and grade for White vs Black patients . However, these studies did not analyze the percentage associated with ERR while including demographic characteristics, comorbidity score, insurance status, neighborhood income, disease stage, histologic subtype, and treatment with surgery, radiotherapy, and/or chemotherapy.…”

Section: Discussionmentioning

confidence: 98%

“…Even among patients with uterine cancer who have equal access to care and receive similar guideline-adherent treatment, racial differences in cancer diagnosis and survival persist . Differences in histologic subtype, disease stage, tumor grade, treatment, supportive services, and molecular features have been implicated in health disparities among patients with uterine cancer …”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

et al. 2023

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ImportanceDisparities in survival exist between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) patients with uterine cancer.ObjectiveTo investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer.Design, Setting, and PatientsThis cohort study used data from the National Cancer Database on 274 838 Black and White patients who received a diagnosis of uterine cancer from January 1, 2004, to December 31, 2017, with follow-up through December 2020. Statistical analysis was performed in July 2022.Main Outcomes and MeasuresOverall survival by self-reported race and evaluation of explanatory study factors associated with hazard ratio (HR) reduction for Black vs White patients. A propensity scoring approach was applied sequentially to balance racial differences in demographic characteristics, comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment.ResultsThe study included 32 230 Black female patients (mean [SD] age at diagnosis, 63.8 [10.0] years) and 242 608 White female patients (mean [SD] age at diagnosis, 63.5 [10.5] years) and had a median follow-up of 74.0 months (range, 43.5-113.8 months). Black patients were more likely than White patients to have low income (44.1% vs 14.0%), be uninsured (5.7% vs 2.6%), present with nonendometrioid histologic characteristics (46.1% vs 21.6%), have an advanced disease stage (34.1% vs 19.8%), receive first-line chemotherapy (33.8% vs 18.2%), and have worse 5-year survival (58.6% vs 78.5%). Among patients who received a diagnosis at younger than 65 years of age, the HR for death for Black vs White patients was 2.43 (95% CI, 2.34-2.52) in a baseline demographic-adjusted model and 1.29 (95% CI, 1.23-1.35) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 0.8%, 7.2%, 11.5%, 53.1%, 5.8%, 1.2%, and 20.4%, respectively, of the excess relative risk (ERR) among the younger Black vs White patients. Among patients 65 years or older, the HR for death for Black vs White patients was 1.87 (95% CI, 1.81-1.93) in the baseline model and 1.14 (95% CI, 1.09-1.19) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 3.0%, 7.5%, 0.0%, 56.2%, 10.6%, 6.9%, and 15.8%, respectively, of the ERR among Black vs White patients aged 65 years or older.Conclusions and RelevanceThis study suggests that histologic subtype was the dominant factor associated with racial survival disparity among patients with uterine cancer, while insurance status represented the main modifiable factor for women younger than 65 years. Additional studies of interactions between biology and social determinants of health are merited.

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“…Most outcome disparities were again noted in stage I disease, with adjustment for treatment-specific factors ameliorating survival differences in higher stage disease. The authors suggest that these findings likely reflect differences in recurrence rates of early-stage disease and treatment for recurrent disease, which often includes clinical trials [23]. Unequal access to clinical trials is described below.…”

Section: Inequalities Across the Spectrum Of Carementioning

confidence: 99%

Alarming trends and disparities in high-risk endometrial cancer

Eakin

Lai

Cohen

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo summarize the most recent publications highlighting the trends and disparities among patients diagnosed with high-risk endometrial cancer.Recent findingsEndometrial cancer mortality continues to rise, driven by the increasing incidence of high-risk histologic subtypes that accounts for a disproportionate number of endometrial cancer deaths. The lack of progress made in endometrial cancer treatment, particularly of high-risk histologic subtypes, disproportionately affects black women who are more likely to be diagnosed with these aggressive tumor types. Even when accounting for high-risk histology, various factors across the spectrum of care may influence the survival disparities between black and white women, including timely access to guideline-concordant care, clinical trial enrollment, and systemic racism that impacts cancer outcomes.SummaryIn this review, we highlight the disproportionate impact of worsening endometrial cancer mortality and healthcare inequalities contributing to the endometrial cancer survival disparity between black and white women.

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Disparities in cancer-specific and overall survival in black women with endometrial cancer: A Medicare-SEER study

Cited by 9 publications

References 21 publications

Cancer treatment and survivorship statistics, 2022

Cancer treatment and survivorship statistics, 2022

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

Alarming trends and disparities in high-risk endometrial cancer

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