Factors influencing molecular tumor profiling in uterine cancer: overcoming health disparities in the Deep South

Abstract

<h3>Objectives:</h3> Molecular tumor profiling has become increasingly utilized in gynecologic cancers in order to guide treatment management and predict prognosis. Prior data demonstrates that insurance status or race can impact a patient's ability to access molecular tumor profiling. We aim to examine factors that correlate with patients undergoing molecular tumor profiling in order to identify patients that are not receiving tumor profiling who could potentially benefit. <h3>Methods:</h3> A retrospective cohort study was performed on uterine cancer patients diagnosed and treated at a large academic institute in the deep south between 2012 and 2018 with adequate follow up. Molecular profiling was performed via IHC and a 592 gene NextGen Sequencing platform. Clinicopathologic data was abstracted and used for comparative analyses. <h3>Results:</h3> Of 1013 uterine cancer patients that were identified, 11.1% (n=112) had molecular profiling performed. Black women were significantly more likely to have molecular testing than White women (19.4% vs 8.12%, p<0.001). Type of insurance did not alter use of molecular testing with Private insurance (8.9%), Medicare (12.5%), Medicaid (5.3%), and Self Pay (10.8%) statistically similar (p=0.23). With regards to pathology, increasing grade correlated with increased molecular testing (p<0.001), as did high risk vs low risk histology (28% vs 5%, p<0.001). Thirty of the 33 (90.9) grade 1 tumors were tested at the time of recurrence. Increasing stage also correlated with an increase in molecular testing (stage 1-4: 4.7%, 19.2%, 48.4%, and 48.2% respectively, p<0.001). Of patients that had molecular testing, 80% received adjuvant therapy and 67.0% had recurrent disease (p<0.001). <h3>Conclusions:</h3> Utilization of molecular profiling in uterine cancers was performed in appropriate clinical scenarios of those who required adjuvant therapy or recurrence. Previously reported obstacles to molecular profiling were not seen in our dataset as payer status or race did not negatively affect appropriate use.