The impact of wait times on oncological outcome in high‐risk patients with endometrial cancer

Mitric, Cristina; Matanes, Emad; Wissing, Michel D.; Amajoud, Zainab; Abitbol, Jeremie; Yasmeen, Amber; López-Ozuna, Vanessa M.; Eisenberg, Neta; Laskov, Ido; Salvador, Shannon; Gotlieb, Walter H.; Kogan, Liron

doi:10.1002/jso.25929

Cited by 5 publications

(15 citation statements)

References 19 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The absence of this logical negative association may be related to the higher prevalence of Type I carcinomas, with a slow evolution and better prognosis. Other similar studies considered that some cases were not endometrial carcinoma when symptoms started but it then evolved into cancer during the wait [11,12,14]. Despite these explanations, it cannot be overlooked that 46%-56% of diagnoses were made more than six months after symptom onset, even though the cases evaluated came from a developed region of Brazil.…”

Section: Discussionmentioning

confidence: 97%

“…Aspiration biopsies were rarely used for diagnoses, somewhat more in Type II (24% vs. 11% for Type I), perhaps due to the greater severity of symptoms at presentation requiring a more urgent diagnosis and treatment. The low proportion of aspiration biopsies used, a simple method for diagnosis of symptomatic women, although not accessible in the Brazilian Public Health System, can justify in part the long waiting time observed for the diagnosis, greater than eight months on average, when compared to the few weeks usually reported for other countries [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…A possible explanation was the relatively low aggressiveness of the endometrioid histology considered [9]. A similar lack of association has already been described for other neoplasms, and recent studies with endometrial carcinomas have focused only on assessing the delay to start treatment, also with controversial results [11][12][13][14].…”

Section: Introductionmentioning

confidence: 85%

See 2 more Smart Citations

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

2023

European Journal of Gynaecological Oncology

View full text Add to dashboard Cite

The aim of this study was to assess the elapsed time for symptomatic women with endometrial carcinoma to achieve diagnosis and treatment and its impact on staging and survival. A cohort study was carried out with 430 women divided into in two groups: “Type I” (n = 289, endometrioid carcinoma grade 1 or 2); “Type II” (n = 141, nonendometrioid, endometrioid carcinoma grade 3, or carcinosarcoma). Clinical information, diagnostic methods, histology, staging, and time elapsed between symptoms-diagnosis-treatment were considered. Descriptive, survival, and regression analyses were performed. The symptom-to-diagnosis interval was 284 and 249 days in Types I and II (p = 0.014), with only 30% getting a diagnosis within 90 days. The diagnosis-to-treatment interval was shorter for Type II (100 vs. 123 days for Type I; p = 0.001). Only 12.5% of Type I and 22.7% of Type II started treatment within 60 days after diagnosis. There was no association between symptom-to-diagnosis interval and staging (p = 0.377). The symptom-to-treatment interval did not change the overall survival for Type I and had a paradoxical effect for Type II, with greater overall survival associated with a longer elapsed time (p = 0.003). Symptomatic Brazilian women with endometrial carcinomas showed very long wait times for diagnosis and treatment, and less than 23% started treatment within the regulatory period of 60 days. This critical situation does not exhibit any clear effect on cancer staging or overall survival, possibly counterbalanced by the faster care of patients with a poor prognosis, such as those with Type II endometrial carcinomas.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 85%

See 1 more Smart Citation

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

2023

European Journal of Gynaecological Oncology

View full text Add to dashboard Cite

show abstract

“…24 Other studies have shown that a longer time to surgery did not increase the risk of receipt of adjuvant chemotherapy for low-risk endometrial cancers and did not affect survival for patients with high-risk tumors. [24][25][26] Specifically looking at nonendometrioid histology, Nica and colleagues 27 found that delays of more than 45 days for surgery did result in decreased overall survival.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hysterectomy Rates Associated With the Coronavirus Disease 2019 (COVID-19) Pandemic

Emont

Wen

Friedman

et al. 2023

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE: To compare nationwide trends in the rate of inpatient and outpatient hysterectomy between 2019 and 2020 during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using weighted data from the National Inpatient Sample and the National Ambulatory Surgery Sample, we examined the number of hysterectomies performed by month from 2019 through 2020. Monthly trends were compared between years overall, stratified by the route of surgery (abdominal, laparoscopic, and vaginal) and by indication for surgery (benign, preinvasive, cancer). Trends analyses were conducted using Joinpoint regression and reported as average monthly percentage change (AMPC). Differences in demographic characteristics between the years were compared using χ2 tests. RESULTS: From January 2019 through December 2020, after weighting, 1,029,792 hysterectomies were performed, including 548,802 (53.2%) in 2019 and 480,990 (46.7%) in 2020. Starting in January 2020, monthly cases declined significantly, from 40,240 to a nadir of 10,566 hysterectomies in April 2020 (AMPC −29.2%, 95% CI −39.8% to −16.8%) (P<.001). The subsequent months saw a significant increase in cases, from the nadir in April 2020 to 40,023 cases in July 2020 (AMPC 39.4%, 95% CI 18.6–63.9%) (P=.001), which then stabilized to the end of the year (AMPC −1.3%, 95% CI −4.8% to 2.4%) (P=.46). In March 2020 there was a 24.0% decrease, in April 2020 a 74.2% decrease, and in May 2020 a 35.1% decrease compared with the respective months in 2019. The rates of vaginal hysterectomy declined more than the rates of other routes of surgery, and procedures performed for benign and preinvasive disease decreased more than those for cancer. CONCLUSION: The rate of hysterectomy in the United States decreased in 2020 compared with 2019, with the greatest decrease from March to May of 2020, corresponding with the initial wave of COVID-19.

show abstract

“…Previous studies have demonstrated no consistent association between time to diagnosis and ovarian cancer survival 11 13 15 22. In endometrial and cervical cancer, data are likewise mixed on whether delayed treatment is associated with worse survival 23–26. Outside of gynecologic oncology, delayed treatment has been shown to worsen survival in some sites,27 28 with no difference in others 29 30…”

Section: Discussionmentioning

confidence: 99%

Association between time to diagnosis, time to treatment, and ovarian cancer survival in the United States

Huepenbecker

Sun

et al. 2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveEvaluate the association between time to diagnosis and treatment of advanced ovarian cancer with overall and ovarian cancer specific mortality using a retrospective cross sectional study of a population based cancer registry database.MethodsThe Surveillance, Epidemiology, and End Results–Medicare database was searched from 1992 to 2015 for women aged ≥66 years with epithelial ovarian cancer and abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of cancer diagnosis. Time from presentation to diagnosis and treatment were evaluated as outcomes and covariables. Cox regression models and adjusted Kaplan–Meier curves evaluated 5 year overall and cancer-specific survival.ResultsAmong 13 872 women, better survival was associated with longer time from presentation to diagnosis (overall survival hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.94 to 0.95; cancer specific survival HR 0.95, 95% CI 0.94 to 0.96) and diagnosis to treatment (overall survival HR 0.94, 95% CI 0.92 to 0.96; cancer specific survival HR 0.93, 95% CI 0.91 to 0.96). There was longer time from presentation to diagnosis in Hispanic women (relative risk (RR) 1.21, 95% CI 1.12 to 1.32) and from diagnosis to treatment in non-Hispanic black women (RR 1.36, 95% CI 1.21 to 1.54), with lower likelihood of survival at 5 years after adjustment for time to diagnosis and treatment among non-Hispanic black women (HR 1.15, 95% CI 1.05 to 1.26) compared with non-Hispanic white women. Gynecologic oncology visit was associated with improved overall (p<0.001) and cancer specific (p<0.001) survival despite a longer time from presentation to treatment (p<0.001).ConclusionLonger time to diagnosis and treatment were associated with improved survival, suggesting that tumor specific features are more important prognostic factors than the time interval of workup and treatment. Significant sociodemographic disparities indicate social determinants of health influencing workup and care. Gynecologic oncologist visits were associated with improved survival, highlighting the importance of appropriate referral for suspected ovarian cancer.

show abstract

The impact of wait times on oncological outcome in high‐risk patients with endometrial cancer

Cited by 5 publications

References 19 publications

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

Trends in Hysterectomy Rates Associated With the Coronavirus Disease 2019 (COVID-19) Pandemic

Association between time to diagnosis, time to treatment, and ovarian cancer survival in the United States

Contact Info

Product

Resources

About