Effect of regionalization of endometrial cancer care on site of care and patient travel

Knisely, Anne; Huang, Yongmei; Melamed, Alexander; Tergas, Ana I.; Clair, Caryn M. St.; Hou, June Y.; Khoury‐Collado, Fady; Ananth, Cande V.; Neugut, Alfred I.; Hershman, Dawn L.; Wright, Jason D.

doi:10.1016/j.ajog.2019.07.026

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…49 A New York cohort saw the greatest distance traveled for those with private insurance (P,.001); that distance increased most over the study period for those with private insurance (31.8%, 95% CI 26.2-37.4) and for White people (4.2 miles, 95% CI 3.4-5.0, P,.001), with nonsignificant changes for Hispanic and Black people. 50 Likewise, a Maryland cohort study reported that, after rurality was incorporated, White people were up to two times more likely to travel more than 50 miles for endometrial cancer surgery, and the effect of rurality increased when accounting for race. 51 The association of distance traveled for care with race and insurance status varied between regional studies.…”

Section: Resultsmentioning

confidence: 99%

“…51 The association of distance traveled for care with race and insurance status varied between regional studies. Although the geography of these trends could reflect disinvesting in communities of color 50,51 and barriers to health care access for rural communities of color, 49 this has not been directly studied, and no relevant interventions were identified.…”

Section: Resultsmentioning

confidence: 99%

“… 13 , 48 This imprecision obfuscates the experiences of at-risk populations; this review found that those with other or unknown race had significantly different outcomes compared with White comparator groups. 34 , 36 , 50 Analytical design can perpetuate gaps in data representation. Asian people were explicitly represented in 14 studies, five of which performed multivariate analysis, but only two included Asian people in multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Timeliness of Endometrial Cancer Care

Najor,

Melson,

Lyu

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: We use the person-centered Pathway to Treatment framework to assess the scope of evidence on disparities in endometrial cancer stage at diagnosis. This report is intended to facilitate interventions, research, and advocacy that reduce disparities. DATA SOURCES: We completed a structured search of electronic databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. Included studies were published between January 2000 and 2023 and addressed marginalized population(s) in the United States with the ability to develop endometrial cancer and addressed variable(s) outlined in the Pathway to Treatment. METHODS OF STUDY SELECTION: Our database search strategy was designed for sensitivity to identify studies on disparate prolongation of the Pathway to Treatment for endometrial cancer, tallying 2,171. Inclusion criteria were broad, yet only 24 studies addressed this issue. All articles were independently screened by two reviewers. TABULATION, INTEGRATION, AND RESULTS: Twenty-four studies were included: 10 on symptom appraisal, five on help seeking, five on diagnosis, and 10 on pretreatment intervals. Quality rankings were heterogeneous, between 3 and 9 (median 7.2) per the Newcastle–Ottawa Scale. We identified three qualitative, two participatory, and two intervention studies. Studies on help seeking predominantly investigate patient-driven delays. When disease factors were controlled for, delays of the pretreatment interval were independently associated with racism toward Black and Hispanic people, less education, lower socioeconomic status, and nonprivate insurance. CONCLUSIONS: Evidence gaps on disparities in timeliness of endometrial cancer care reveal emphasis of patient-driven help-seeking delays, reliance on health care–derived databases, underutilization of participatory methods, and a paucity of intervention studies. SYSTEMATIC REVIEW REGISTRATION: Given that PROSPERO was not accepting systematic scoping review protocols at the time this study began, this study protocol was shared a priori through Open Science Framework on January 13, 2021 (doi: 10.17605/OSF.IO/V2ZXY), and through peer review publication on April 13, 2021 (doi: https://doi.org/10.1186/s13643-021-01649-x).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Disparities in Timeliness of Endometrial Cancer Care

Najor,

Melson,

Lyu

et al. 2023

Obstetrics &Amp; Gynecology

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“…Pain due to tumor infiltration and invasion of peripheral sensory nerves is characterized by acuteness, persistence, and progressive aggravation. Mild stimulation can cause severe pain, which can seriously affect patients’ psychological and physiological functions and reduce patient compliance with treatment, posing a barrier to comprehensive treatment of patients ( 74 , 75 ). For such patients, minimally invasive interventional therapy is recommended.…”

Section: Management Of Painmentioning

confidence: 99%

Pain nursing for gynecologic cancer patients

Wu¹,

He²,

Li³

et al. 2023

Front. Oncol.

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Gynecological malignancy remains a prevalent cause of mortality among women. Chronic cancer pain, as a severe complication of malignancy and its therapies, accounts for a substantial burden of physical and psychological distress in affected patients. Accordingly, early identification, assessment, and standardized management of such pain are crucial in the prevention or delay of its progression. In the present review, we provide a comprehensive overview of the pathological factors that contribute to pain in patients with gynecological malignancy while highlighting the underlying mechanisms of pain in this population. In addition, we summarize several treatment modalities targeting pain management in gynecologic cancer patients, including surgery, radiotherapy, and chemotherapy. These interventions are crucial for tumor elimination and patient survival. Chronic cancer pain exerts a significant impact on wellbeing and quality of life for patients with gynecologic cancer. Therefore, our review emphasizes the importance of addressing this pain and its psychological sequelae and advocates for a multidisciplinary approach that encompasses nursing and psychological support. In summary, this review offers valuable insights into the pathological factors underlying pain, reviews pain management modalities, and stresses the critical role of early intervention and comprehensive care in enhancing the quality of life of these patients.

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“…Regionalization of cancer surgery has impacted other areas of interest, in addition to treatment and oncologic outcomes. 21,26 A recent analysis of population-based data in the state of New York found that the distance that patients with endometrial cancer have to travel to receive care has increased significantly over the 15-year study period 21 during which natural regionalization of care occurred. Our data show that regionalization of care for patients with high-grade endometrial cancer has led to an increase in the mean distance traveled to receive surgery of 7 km.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Outcomes after the regionalization of care for high-grade endometrial cancers: a population-based study

Nica

Sutradhar

Kupets

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND:In June 2013, Ontario Health (Cancer Care Ontario), the agency responsible for advancing cancer care in Ontario, Canada, published practice guidelines recommending that gynecologic oncologists at tertiary care centers manage the treatment of patients with high-grade endometrial cancers. This study examines the effects of this regionalization of care on patient outcomes. OBJECTIVE: This study aimed to evaluate the impact of the regionalization of surgery for high-grade endometrial cancer on patient and treatment outcomes. STUDY DESIGN: In this retrospective cohort study, patients diagnosed with nonendometrioid high-grade endometrial cancer from 2003 to 2017 were identified using province-wide administrative databases. To allow 6 months for knowledge translation, 2 periods were defined, with January 1, 2014, as the cutoff. Methods for segmented regression were used to test the effect of the guidelines. Multivariable Cox proportional hazards regression was used to evaluate whether regionalization of care had an impact on patient survival. RESULTS: There were 3518 patients with nonendometrioid highgrade endometrial cancer identified. The case mix as represented by patient comorbidities and the disease stage distribution did not differ significantly between the 2 regionalization periods. There was a significant increase (69%e85%; P<.001) in the proportion of primary surgeries performed by gynecologic oncologists after regionalization, which was not explained by secular trends. After regionalization, the proportion of patients who had surgical staging (50%e63%; P<.001) and the proportion of patients who received adjuvant treatment (65%e71%; P<.001) increased significantly. After adjusting for age, stage, and comorbidities, there was a decrease in the hazard of mortality (hazard ratio, 0.85 [95% confidence interval, 0.73e0.99]; P¼.04) after regionalization. CONCLUSION: The publication of a regionalization policy for the treatment of high-grade endometrial cancers in Ontario led to an increase in the proportion of surgeries performed by gynecologic oncologists. This also translated into a significant improvement in patient survival.

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Effect of regionalization of endometrial cancer care on site of care and patient travel

Cited by 8 publications

References 35 publications

Disparities in Timeliness of Endometrial Cancer Care

Disparities in Timeliness of Endometrial Cancer Care

Pain nursing for gynecologic cancer patients

Outcomes after the regionalization of care for high-grade endometrial cancers: a population-based study

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