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. 2021 Jul 15;127(14):2423-2431.
doi: 10.1002/cncr.33502. Epub 2021 Mar 15.

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

Victoria E Rodriguez  1 , Alana M W LeBrón  1   2 , Jenny Chang  3 , Robert E Bristow  4
Affiliations

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

Victoria E Rodriguez et al. Cancer. .

Abstract

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.

Keywords: endometrial neoplasms; health care disparities; race; social class; survival analysis; treatment adherence.

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Conflict of interest statement

Conflict of Interest: The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.. Study Population Exclusions
This diagram details how patients diagnosed between 2006 and 2015 were included in the study. SEER, Surveillance, Epidemiology, and End Results
Figure 2.
Figure 2.
Kaplan-Meier Survival Estimates by Adherence to NCCN Treatment Guidelines among Endometrial Carcinoma Patients, SEER 2006 - 2015 SEER, Surveillance, Epidemiology, and End Results
See this image and copyright information in PMC

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