Quality of care and survival of women with uterine cancer by Hispanic origin: An NCDB analysis.

Abstract

e17120 Background: In cancer research in the US, Hispanic patients are often analyzed as a homogeneous group despite significant diversity within this ethnic classification. Our objective was to assess the impact of place of origin on quality of care and overall survival for Hispanic women with uterine cancer living in the US. Methods: The National Cancer Database (NCDB) was used to identify all patients with uterine cancer from 2004-2015. Hispanic origin was classified based on NCDB subgroups: Mexican, Puerto Rican, Cuban, South or Central American, and Dominican Republic. Multivariable models were used to assess the adjusted relative risk (aRR) of receiving quality of care indicators. Thirty-day mortality and overall 5-year survival were calculated using multivariable log-Poisson and Cox proportional Hazard models. Results: A total of 5,411 Hispanic women and 288,111 non-Hispanic women were identified. Of Hispanic women, Mexican patients comprised the largest subgroup (n = 2,512), and increased from 34.5% to 49.7% over the study period. South or Central American (n = 1,217) and Dominican (n = 218) patients also increased modestly, while the volume of Puerto Rican patients remained unchanged (n = 877), and Cuban patients decreased from 23.3% to 5.6% (n = 587). Compared to non-Hispanic women, there were no significant differences in the rates of use of minimally invasive surgery, chemotherapy in early stage high risk disease, lymph node dissection, or 30-day readmission among the Hispanic subpopulations. Rates of chemotherapy for advanced stage disease were modestly increased for Dominican (aRR 1.37, 95%CI (1.23-1.54)) and South or Central American (aRR 1.16, 95%CI (1.05,1.29)) groups. Dominican patients had a statistically significant reduction in overall mortality at five years for stage III and IV disease with aHR 0.38, 95%CI (0.16-0.90) and aHR 0.28, 95%CI (0.09, 0.87), respectively. For all other Hispanic subgroups, there were no differences in stage-specific survival. Conclusions: The diversity within the Hispanic cohort of women with uterine cancer in NCDB is changing. Overall quality indicators and survival outcomes are comparable between each Hispanic origin group, with the exception of advanced stage Dominican women who are more likely to receive chemotherapy, and have superior survival outcomes.