Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

Abstract

ObjectiveObesity is a major risk factor for low-grade endometrial cancer. The surgical management of patients with obesity is challenging, and they may face unique barriers to accessing care. We completed a qualitative study to understand the experiences of low-grade endometrial cancer patients with morbid obesity, from symptom onset to diagnosis to surgery.DesignSemi-structured interviews were performed with endometrial cancer patients with morbid obesity (body mass index (BMI)>40 kg/m2) referred for primary surgery. Transcribed interviews were coded line-by-line and analysed using an interpretive descriptive approach that drew on labelling theory to understand patients’ experiences. Thematic sufficiency was confirmed after 15 interviews.SettingTwo tertiary care centres in Toronto, Ontario, Canada.ParticipantsFifteen endometrial cancer patients with a median age of 61 years (range: 50–74) and a median BMI of 50 kg/m2(range: 44–70) were interviewed.ResultsThematic analysis identified that (1) both patients and providers lack knowledge on endometrial cancer and its presenting symptoms and risk factors; (2) patients with morbid obesity are subject to stigma and poor communication in the healthcare system and (3, 4) although clinical, administrative, financial, geographic and facility-related barriers exist, quality care for patients with morbid obesity is an achievable goal.ConclusionsImproved education on the prevention and identification of endometrial cancer is needed for both patients and providers. Delivery of cancer care to patients with morbid obesity may be improved through provider awareness of the impact of weight stigma and establishing streamlined care pathways at centres equipped to manage surgical complexity.

The Impact of Obesity on Surgical Complications and Disease Recurrence in Endometrial Cancer: A Retrospective Study of 267 Patients

“…In our study, we examined the impact of obesity on the operative complications and recurrence in patients with endometrial cancer in an Egyptian cancer care setting. Type I endometrial cancers were more common in obese patients in our study as reported by others [12][13][14] . As regard the operative procedures, obesity did not significantly impact the surgical procedures in both groups as regard the number of patients who underwent lymphadenectomy, the median number of harvested lymph nodes and the intraoperative complications.…”

Beyond the numbers—understanding women’s experiences of accessing care for abnormal uterine bleeding (AUB): a qualitative study

“…The first, also placed in NZ, reported similar stories of self-doubt and confusion around their symptoms. 23 The second, placed in Canada, investigated morbidly obese women diagnosed with low-grade endometrial cancer 24 and focused on barriers to surgery for this group of women. This study found that women with endometrial cancer were subject to stigma and poor provider communication, and that many of the participants learnt about the link between endometrial cancer and obesity through their own reading.…”

“…This study found that women with endometrial cancer were subject to stigma and poor provider communication, and that many of the participants learnt about the link between endometrial cancer and obesity through their own reading. 24 Participants also noted their reluctance to seek care due to prior stigmatisation experiences. 24 These issues were similarly reported by a number of participants in our study.…”

“… 24 Participants also noted their reluctance to seek care due to prior stigmatisation experiences. 24 These issues were similarly reported by a number of participants in our study.…”

Beyond the numbers- understanding women’s journey’s to clinic for abnormal uterine bleeding (AUB): a qualitative study.

“…The first, also placed in New Zealand, reported similar stories of self-doubt and confusion around their symptoms (19). The second, placed in Canada, investigated morbidly obese women diagnosed with low grade endometrial cancer (20) and focused on barriers to surgery for this group of women. This study found that women with endometrial cancer were subject to stigma and poor provider communication and that many of the participants learnt about the link between endometrial cancer and obesity through their own reading (20).…”