Mitigating disparity? Recurrence rates and palliative care referrals by race and ethnicity across a large urban health system (514)

Abstract

<b>Objectives:</b> National data have shown that survival outcomes and care delivery for endometrial cancer are worse among racial and ethnic minorities. Our group previously showed that care at a highvolume academic center alleviated disparities in survival and standard of care treatment in women with advanced endometrial cancer. Our study aimed to expand this inquiry to include two affiliated non-academic hospitals within our healthcare system and include all stages. We also assessed for disparities in recurrence rates and palliative care referrals by race and ethnicity. <b>Methods:</b> A review of women with endometrial cancer from January 1, 2006, and December 31, 2017, was performed at three hospitals within our large urban health system. Charts were identified via the institutional tumor registry. Those without complete clinical data were excluded. Demographics, socioeconomic data, and clinical variables were collected. Logistic regressions were generated to determine differences in recurrence rates and palliative care referrals by hospital, race, and ethnicity. <b>Results:</b> Of a total of 1978 charts, 1224 were suitable for analysis. There were 763 White (62.3%), 195 Black (15.9%), 123 Asian (10%), and 143 other (11.7%) women; 181 were Hispanic (14.8%) versus 1006 non-Hispanic (82.1%). Eighty-three percent of the cohort was still alive at the time of the study, with a 17% death rate. In comparison to the main hospital, one affiliated hospital had no difference in recurrence rates, while the other had lower recurrence rates after controlling for race and stage (OR site 1: 0.323, 95% CI: 0.240-0.432; OR site 2: 0.965, 95% CI: 0.715-1.305). Furthermore, there were no differences in recurrences between Black, Asian, and Other races in comparison to White women after controlling for stage and hospital (OR Black: 1.197, 95% CI: 0.849-1.691; OR Asian: 0.584, 95% CI: 0.294-1.110; OR Other: 0.749, 95% CI: 0.539-1.038). There was also no difference in recurrence when comparing Hispanic versus Non-Hispanic women (OR: 0.962, 95% CI: 0.700-1.320). There were no differences in palliative referrals between the main hospital and sites 1 or 2 (OR Site 1: 0.896, 95% CI: 0.564-1.409; OR Site 2: 0.00, 95% CI: 0.00-34.3). When controlling for stage and hospital site, Black and Asian women were more likely to be referred to palliative care than White women (OR Black: 2.176, 95% CI: 1.291-3.623; Asian: 2.675, 95% CI: 1.142-5.868). There were no differences in palliative care referral rates between Hispanic and Non-Hispanic women (OR: 0.869, 95% CI: 0.478-1.500). <b>Conclusions:</b> Current findings validate our previously demonstrated results at a health system level. The delivery of care for endometrial cancer at an academic medical center appears to mitigate racial and ethnic disparities in survival and quality of life outcomes seen nationally. This persists within a large health system and is not limited to only the main academic center. Black, Asian, and Hispanic women are equally or more likely to be referred to palliative care, perhaps due to being diagnosed at later stages. Recurrence rates are unchanged in these populations.