Abstract A02: Disparities in the Treatment of High-Grade Endometrial Cancer: Analysis of the National Cancer Database

Abstract

Abstract OBJECTIVE: To examine patterns of care and survival for Non-Hispanic White (NHW), Non-Hispanic African American (NHAA) and Hispanic women with high-grade endometrial cancer. METHODS: We utilized the National Cancer Data Base (NCDB) to identify women diagnosed with uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear cell carcinoma and papillary serous carcinoma between 2003-2011. The variables of interest were race and ethnicity. For this, race and ethnicity were used to construct single mutually exclusive race-ethnicity variables (non-Hispanic white, black, white-Hispanic, or other and unknown). The primary outcome of interest was overall survival, defined as months from cancer diagnosis to death or date of the last contact. Secondary outcomes were the receipt of initial treatment after diagnosis of high-grade endometrial cancer. Continuous variables were evaluated by ANOVA and categorical variables were evaluated by chi square test. Pair-wise comparisons among continuous and categorical variables utilized the Holm-Bonferroni method to adjust for multiple comparisons. Logistic regression models were performed to describe predictors of treatment, after adjusting for prognostic factors expected to be associated including age, race, stage, histology, year of treatment, facility type, location, insurance type, and comorbidity score. The effect of treatment modality on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. RESULTS: 44,080 women were eligible for inclusion. NHAA and Hispanic women had higher rates of stage III and IV disease compared to NHW women (21.3% vs. 19.4% vs. 15.5%, p<0.001). NHAA women were less likely to undergo definitive surgical treatment for their cancer (10.9% vs. 6.7% vs. 6.4%, p<0.001) and were more likely to receive adjuvant chemotherapy (36.8% vs. 32.4% vs. 32.0%, p< 0.001) compared to NHW and Hispanic women. Multivariate analyses of treatment patterns controlling for clinical, pathologic and demographic factors demonstrated that NHAA women were less likely to receive surgical treatment compared to NHW women (Odds Ratio 0.65, 95% CI 0.51-0.83). There was no significant difference in surgical treatment between whites and Hispanics (Odds Ratio 0.88, 0.57-1.37). There was no racial or ethnic difference in rates of adjuvant chemotherapy or radiation. Over the entire study period, after adjusting for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, NHAA women had lower overall survival compared to NHW women (Hazard Ratio 1.21, 95% CI 1.16-1.26). Conversely, Hispanic women had an improved overall survival after controlling for the aforementioned factors (Hazard Ratio 0.87, 95% CI 0.80-0.93). CONCLUSION: Among women with high-grade endometrial cancer, NHAA women were less likely to receive surgical treatment when compared to NHW women. NHAA women have lower all-cause survival compared to Non-Hispanic white women while Hispanic women have higher all-cause survival compared to Non-Hispanic white women after controlling for treatment, sociodemographics, comorbidities, and histopathologic variables. Citation Format: Jose Alejandro Rauh-Hain, Amy J. Bregar, Joel T. Clemmer, Marcela G. del Carmen. Disparities in the Treatment of High-Grade Endometrial Cancer: Analysis of the National Cancer Database. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A02.