Loss to Follow-up in Fertility-Sparing Management of Endometrial Cancer and Pre-cancer [ID 2683403

Abstract

INTRODUCTION: Follow-up is essential with conservatively managed endometrial cancer (EC) and endometrial intraepithelial neoplasia (EIN) due to high risk of recurrence. There are little published data regarding follow-up in this population. The purpose of this study was to assess possible factors associated with loss to follow-up. METHODS: This was an IRB-approved retrospective chart review (protocol HSC20220315EX). Patients aged 18–45 with a history of EIN or early EC who elected fertility-sparing management and achieved pathologic response were included. Demographic and clinical data were collected and compared across patients who followed up and did not follow up. RESULTS: Eighty-six patients met inclusion criteria, of which 40 were lost to follow-up. 52% of patients with EIN and 25% of patients with EC were lost to follow-up (P=.12). 43% of patients with private insurance were lost to follow-up, compared to 63% with Medicaid (P=.45) and 67% without insurance (P=.40). There was no difference in follow-up based on age (P=.24), race (P=.47), body mass index (P=.90), or parity (P>.99), nor was there a difference based on fertility consultation (P=.83), assisted reproductive technology utilization (P>.99), or achievement of pregnancy (P>.99). CONCLUSION: Although no statistical differences were found, trends towards difference in follow-up based on diagnosis and insurance warrant further investigation. Barriers to care also may be more individual than systemic in nature. A future survey study of patients lost to follow-up may provide additional insight.