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

• Published in: Cancer Vol. 127; no. 14; pp. 2423 - 2431
• Main Authors: Rodriguez, Victoria E., LeBrón, Alana M. W., Chang, Jenny, Bristow, Robert E.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.07.2021
• Subjects: Cancer; Carcinoma; Endometrial cancer; endometrial neoplasms; Endometrial Neoplasms - therapy; Endometrium; Epidemiology; Ethnic factors; Ethnicity; Female; Guidelines; health care disparities; Health services; Healthcare Disparities; Humans; Minority & ethnic groups; Oncology; Pacific Islander people; Patient compliance; Physicians; Race; Racial Groups; Social Class; Socioeconomic factors; Socioeconomics; Statistical models; Survival; survival analysis; Survival Rate; treatment adherence; Uterine cancer; health care disparities; race; survival analysis; treatment adherence; social class; endometrial neoplasms
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.33502

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. National Comprehensive Cancer Network‐treatment adherence is an independent predictor of endometrial cancer survival. However, even after adjustment for treatment adherence, racial/ethnic and socioeconomic disparities in survival persist.