Evidence-based guidelines increase uptake and decrease racial disparities in endometrioid endometrial cancer patients electing ovarian preservation (573)

Abstract

Objectives: To evaluate trends over time and identify demographic factors associated with the pursuit of ovarian preservation before and after implementing evidence-based guidelines among endometrioid endometrial cancer patients aged ≤50 years, treated at a single institution. Methods: In December 2018, evidence-based institutional guidelines were introduced detailing when to offer ovarian preservation for low-grade endometrioid endometrial cancer patients. The guidelines included patients aged 50 or younger, patients who desire to preserve hormonal function, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome, and no personal history of hormone receptor-positive malignancy. Trends in ovarian preservation over time were examined, with the Cochran-Armitage trend test p-value was reported. Associations between choosing ovarian preservation and age, body mass index classification (normal, overweight, obese), race/ethnicity, marital status, and insurance type, before and after guideline implementation, were compared using the Wilcoxon rank-sum and Fisher’s exact tests. Results: From January 2010, 420 women aged <50 years underwent staging surgery for endometrioid endometrial cancer, and 355 (85%) met the criteria for ovarian preservation; 267 before and 88 after guideline introduction. Patients qualifying for ovarian preservation were significantly more likely to choose ovarian preservation after guideline implementation (43%) versus before guideline implementation (18%) (p<0.001, Figure 1). Before guideline introduction, 12% (17/144) of White women elected ovarian preservation compared with 28% (23/82) of non-White women (p=0.003). Similarly, 13% (25/196) of women aged >40 years elected ovarian preservation compared with 44% (31/71) of women aged <40 years (p<0.001). There were no differences in ovarian preservation rates by obesity status (p=0.68), marital status (p=0.86), or insurance type (p=0.53). After guideline introduction, 36% of White (14/39) and 50% of non-White (15/30) women chose ovarian preservation (p=0.33). Eighteen of 56 (32%) women aged >40 years elected ovarian preservation compared with 24/32 (75%) women aged <40 years (p<0.001). There were no differences in ovarian preservation rates by obesity status (p=0.19), marital status (p=0.45), or insurance type (p>0.99). Conclusions: Implementation of ovarian preservation guidelines for women with endometrial cancer aged <50 years increased rates of ovarian preservation over time. After guideline implementation, there were fewer demographic differences in patients electing ovarian preservation. Objectives: To evaluate trends over time and identify demographic factors associated with the pursuit of ovarian preservation before and after implementing evidence-based guidelines among endometrioid endometrial cancer patients aged ≤50 years, treated at a single institution. Methods: In December 2018, evidence-based institutional guidelines were introduced detailing when to offer ovarian preservation for low-grade endometrioid endometrial cancer patients. The guidelines included patients aged 50 or younger, patients who desire to preserve hormonal function, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome, and no personal history of hormone receptor-positive malignancy. Trends in ovarian preservation over time were examined, with the Cochran-Armitage trend test p-value was reported. Associations between choosing ovarian preservation and age, body mass index classification (normal, overweight, obese), race/ethnicity, marital status, and insurance type, before and after guideline implementation, were compared using the Wilcoxon rank-sum and Fisher’s exact tests. Results: From January 2010, 420 women aged <50 years underwent staging surgery for endometrioid endometrial cancer, and 355 (85%) met the criteria for ovarian preservation; 267 before and 88 after guideline introduction. Patients qualifying for ovarian preservation were significantly more likely to choose ovarian preservation after guideline implementation (43%) versus before guideline implementation (18%) (p<0.001, Figure 1). Before guideline introduction, 12% (17/144) of White women elected ovarian preservation compared with 28% (23/82) of non-White women (p=0.003). Similarly, 13% (25/196) of women aged >40 years elected ovarian preservation compared with 44% (31/71) of women aged <40 years (p<0.001). There were no differences in ovarian preservation rates by obesity status (p=0.68), marital status (p=0.86), or insurance type (p=0.53). After guideline introduction, 36% of White (14/39) and 50% of non-White (15/30) women chose ovarian preservation (p=0.33). Eighteen of 56 (32%) women aged >40 years elected ovarian preservation compared with 24/32 (75%) women aged <40 years (p<0.001). There were no differences in ovarian preservation rates by obesity status (p=0.19), marital status (p=0.45), or insurance type (p>0.99). Conclusions: Implementation of ovarian preservation guidelines for women with endometrial cancer aged <50 years increased rates of ovarian preservation over time. After guideline implementation, there were fewer demographic differences in patients electing ovarian preservation.