Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients

Zahnd, Whitney E.; Hyon, K.S.; Diaz-Sylvester, Paula L.; Izadi, Sonya; Colditz, Graham A.; Brard, Laurent

doi:10.1007/s10552-017-0998-4

Cited by 16 publications

(15 citation statements)

References 42 publications

(49 reference statements)

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“…This includes comorbidities, psychological distress, and lower levels of physical activity [19, 20]. A recent study observed significantly increased risk of death in rural endometrial cancer patients compared to urban patients, however they were not able to include BMI and baseline health which we included [11]. Generally, in our study rural endometrial cancer patients had higher rates of multiple comorbidities.…”

Section: Discussionmentioning

confidence: 86%

“…This may be a result of reduced access to healthcare. Patients in rural areas are likely to live much farther from a cancer center and may have less access to adjuvant therapy, which has been associated with decreased survival [11, 21]. Patients may also be offered therapy, but may decline it due to reasons such as distance and cost.…”

Section: Discussionmentioning

confidence: 99%

“…Rural patients may have a greater geographic accessibility burden, which could account for the differences in treatment have been observed between rural and urban endometrial cancer patients [9, 11]. Rural patients received a less comprehensive surgical evaluation and are less likely to have multimodality treatment and have any lymph nodes removed [9, 11]. These treatment differences have been previously associated with lower survival rural endometrial cancer patients [11].…”

Section: Introductionmentioning

confidence: 99%

“…Rural patients received a less comprehensive surgical evaluation and are less likely to have multimodality treatment and have any lymph nodes removed [9, 11]. These treatment differences have been previously associated with lower survival rural endometrial cancer patients [11]. While previous studies have examined treatment differences as a factor in survival differences, they have not examined how prognostic factors, such as age at diagnosis, baseline health, and stage of diagnosis may be associated with decreased survival in rural areas.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors for rural endometrial cancer patients in a population-based cohort

et al. 2019

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Background Endometrial cancer is the second most common cancer among female cancer survivors in the US and is increasing in incidence. Rural endometrial cancer patients experience lower survival rates but the reasons for the lower survival are not known. The aim of this study is to examine whether prognostic factors are different for rural and urban patients in a population-based cohort. Methods Endometrial cancer patients diagnosed 1997-2012 were identified through the Utah Cancer Registry and Utah Population Database. The address at cancer diagnosis was used to classify patients in rural or urban residences. Demographic and cancer-specific characteristics were examined as prognostic factors for both all-cause and endometrial cancer-specific mortality using Cox proportional hazards models. Results There were 2,994 endometrial cancer patients and 14.1% of these patients lived in rural areas at diagnosis. Rural endometrial cancer patients were older at cancer diagnosis and did not appear to be different in terms of obesity or overweight at cancer diagnosis. There were no differences for treatment or stage at diagnosis although rural patients had higher proportions of higher grade. Age at diagnosis, poverty, education, and histology were significant prognostic factors for all-cause death. Rural patients with more advanced stages of cancer had significantly increased risks of all-cause and endometrial cancer-specific death than urban patients. Rural endometrial cancer patients diagnosed at advanced stage had a 17-fold increase in the risk of all-cause death compared to an 8-fold increase in death for urban patients. Conclusions Rural endometrial cancer patients in Utah were older at diagnosis, had higher grade and higher comorbidities. While urban and rural endometrial cancer patients shared many prognostic factors, the risk of mortality is greater among rural patients with advanced stage endometrial cancer. Future studies should examine where patients are receiving treatment and how that impacts their survival and how to reduce the mortality rates of high risk patients.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic factors for rural endometrial cancer patients in a population-based cohort

et al. 2019

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“…This is often influenced by patient characteristics such as age, comorbidities and patient preference. Furthermore, the type of treatment centre (cancer centre or smaller hospital) also influences the type of treatment offered to patients and influences survival in endometrial cancer patients [35,36]. Patients with low SES are less likely to afford travel costs to cancer centres, especially if they reside in rural counties.…”

Section: Discussionmentioning

confidence: 99%

Systematic review on socioeconomic deprivation and survival in endometrial cancer

Donkers

Bekkers

Massuger

et al. 2019

Cancer Causes Control

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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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Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients

Abstract: Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.

Cited by 16 publications

References 42 publications

Prognostic factors for rural endometrial cancer patients in a population-based cohort

Prognostic factors for rural endometrial cancer patients in a population-based cohort

Systematic review on socioeconomic deprivation and survival in endometrial cancer

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

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