Racial differences in patient-reported distress among women with endometrial cancer

Abstract

Objectives: There are established racial disparities in mortality from endometrial cancer (EC). In addition, distress from cancer diagnosis and treatment is associated with lower compliance and more frequent use of emergency services. Differences in distress by race/ethnicity in EC have not been previously explored. Here we characterize the association between race/ethnicity, distress scores and stressors reported by patients on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT), and referral to support services in women with EC. Methods: Patients presenting to a single academic outpatient gynecologic oncology practice for initial evaluation of known EC from January 2013-May 2020 were included. The electronic health record was used to abstract demographics, NCCN DT scores, and stressor categories (physical, emotional, spiritual, practical, and family) from the initial encounter. At our institution, patients are referred to support services for an NCCN DT score ≥4. We excluded women who received prior cancer-directed therapy and those without an NCCN DT score recorded at their initial appointment. Summary statistics were tabulated for demographics. Mann-Whitney U tests were used for inter-group difference on continuous variables and 2-sample tests for equality of proportions were used for binary variables. Results: 412 non-Hispanic White (NHW, mean age 63) and 149 non-Hispanic Black (NHB, mean age 65) women were included in our analysis. More NHB women presented with high-grade EC (53.7%) vs NHW women (21.9%) and fewer NHB women were privately insured (32% vs 52%). Median distress scores were higher in NHW women compared to their NHB counterparts (4 vs. 2, p Conclusions: The NCCN DT, a widely used tool in cancer clinics, may fail to adequately measure distress in NHB women presenting with a diagnosis of EC, despite >30% more high risk histology cancers in this cohort. This phenomenon appears to be driven by the greater frequency of ‘0’ distress scores reported by NHB women. This difference leads to disparities in referral to additional support services, which may affect quality of care and quality of life. Additional research is needed to better understand how women of different races and ethnicities approach the NCCN DT.