Gynecologic Cancer Outcomes Research Articles

Abstract 2144: Disparities in gynecologic cancer survival outcome by treatment facility and region

Abstract Objective: To explore five-year survival of patients with gynecologic cancers by region and treatment facility in the United States. Background: Research studies have examined the risk factors associated with gynecologic cancers, specifically cervical, ovarian, and endometrial, incidence and mortality. In addition to older age, Black/African American race, living in south, less income, less education, having comorbidity, stages of cancer, and lack of insurance have reported as risk factors for the incidence and mortality of gynecologic cancers. In addition, prior studies reported the possible effects from the distance to cancer care facilities on gynecologic cancer outcomes indicated varying results. In this study, we explore the impact of distance travelled by region and treatment facility on gynecologic cancer outcomes. Methods: This study aims to assess five-year cervical, ovarian, and endometrial cancer survival. Data were obtained from the National Cancer Database (NCDB) years 2004-2017, only from patients with a minimum 5-year follow-up. Women with races other than White or Black were excluded from the study. Demographics, region, treatment center type, distance to the treatment center, and cancer stage at diagnosis were analyzed by cancer type and 5-year survival status. Multivariate logistic regression model was used to assess the relationship between distance travelled to treatment facility by region and five-year survival. SAS version 9.4 was used for statistical analysis. Results: The distribution of the demographics across the three cancers were similar. Multivariate logistic models showed significant interactions between facility type and region on five-year survival among cervical, ovarian and endometrial cancer patients. Risk factors varied by region and treatment facility type. Age and cancer stage were significantly associated with survival among all cancers. Distance was significantly associated with survival in cervical and endometrial cancers. Conclusion: Cervical cancer patients in the South Atlantic who travel longer distances to Academic/Research Programs have poorer survival. Likewise, patients with endometrial cancer who live in New England region, and travel longer distances to Integrated Network Cancer Programs, as well as those who live in the West North Central region and travel longer distances to Community Cancer Programs have poorer survival. Further research is warranted to explore the specifics of region and treatment center types among different cancers to get a better understanding of the risk factors. Moreover, to improve the clinical outcomes, further study is needed to aim to identify which of these factors are actionable. Citation Format: Sejong Bae, Vishruti Pandya, Chenguang Wang, Hao Wang, Rebecca C. Arend, Charles A. Leath, Warner K. Huh. Disparities in gynecologic cancer survival outcome by treatment facility and region [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2144.

Association of Physician Densities and Gynecologic Cancer Outcomes in the United States

ABSTRACT Gynecologic cancers account for approximately 94,000 new cancer diagnosis yearly in the United States, with prognosis largely dependent on stage at diagnosis, sociodemographic, geographic, and other biological factors. Proximity to gynecologic oncologists has been shown to improve cancer outcomes; however, it remains unclear whether physician density of nonsubspecialists such as obstetrician-gynecologists (OBGYNs) or primary care physicians (PCPs) has a similar benefit. The aim of this study was to determine whether there is a correlation between the density of OBGYNs and PCPs with outcomes of patients with gynecologic cancer at the county level in the United States. County-level oncologic and sociodemographic data on cases between 2005 and 2018 were obtained from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database. Female population by county was collected from the United States Census Bureau and physician density information from the Area Health Resources File. Backward stepwise linear regression was performed for both AJCC cancer stage at diagnosis and 5-year survival rate while accounting for county-level sociodemographic factors. A total of 113,938 patients were included in the analysis for AJCC stage at diagnosis and 98,573 for 5-year survival rate. Across all cancer types, the average density was 18 and 114 OBGYNs and PCPs per 100,000 females in metropolitan areas, respectively, whereas the average density was 8 and 89 OBGYNs and PCPs per 100,000 females in nonmetropolitan areas, respectively. Increasing PCP density was associated with an earlier stage at diagnosis for cervical cancer (95% CI, −6.27 to −0.05; P < 0.05), even after adjusting for sociodemographic factors. No correlation between OBGYN density and cervical cancer stage at diagnosis was found. After adjusting for county-level sociodemographic factors, increasing median household income was associated with an earlier stage at diagnosis for cervical cancer (P = 0.01) and increasing percentage of Black females was associated with a later stage at diagnosis for uterine cancer (P < 0.01). Increasing PCP density was associated with an increased 5-year survival rate for cervical cancer (95% CI, 0.03–0.09; P < 0.05). After adjustment for sociodemographic factors, no correlation between OBGYN density and cervical cancer survival was observed, nor was any correlation between PCP or OBGYN density and 5-year survival rate by stage for either endometrial or ovarian cancer. After adjustment for county-level sociodemographic factors, an increasing percentage of those with a bachelor’s degree was associated with an increased 5-year survival in cervical cancer (P < 0.01), an increasing percentage of Black females was associated with a decreased 5-year survival rate for uterine cancer (P < 0.01), and increasing median household income was associated with an increased 5-year survival rate for ovarian cancer (P < 0.01). The results of this study suggest that only cervical cancer outcomes are significantly correlated with PCP density at the county level, possibly because cervical cancer is the only gynecologic cancer with recommended routine screening guidelines.

Association of Physician Densities and Gynecologic Cancer Outcomes in the United States.

To evaluate whether there is an association between county-level obstetrician-gynecologist (ob-gyn) and primary care physician (PCP) densities and gynecologic cancer outcomes in the United States. A retrospective cohort study of gynecologic cancers (uterine, ovarian, and cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from the SEER database, population density from the United States Census Bureau, and physician density (ob-gyns and PCPs/100,000 females) from the Area Health Resources File. Backward stepwise regression models were used. Final analysis included 113,938 patients for stage at diagnosis analysis and 98,573 patients for 5-year survival analysis. Uterine, ovarian, and cervical cancers represented 60.0%, 25.0%, and 15.0% of patients, respectively. Most counties (57%) were nonmetropolitan and had a mean ob-gyn density of 8 per 100,000 females and a mean PCP density of 89 per 100,000 females. Multivariate analysis showed that increasing PCP density was associated with earlier stage at diagnosis (95% CI -6.27 to -0.05; P <.05) and increased 5-year survival rates in cervical cancer (95% CI 0.03-0.09; P <.05). Obstetrician-gynecologist density was not found to affect stage or survival outcomes for uterine or ovarian cancer. Analysis of sociodemographic factors for cervical cancer showed that median household income was negatively correlated with stage ( P =.01) and that the percentage of those with bachelor's degrees and metropolitan status were positively correlated with 5-year survival rates ( P <.01). For uterine cancer, the percentage of Black females was positively correlated with stage ( P <.01) and negatively correlated with 5-year survival rates ( P <.01). Increasing PCP density, but not ob-gyn density, is associated with earlier stage at diagnosis and improved 5-year survival rates in cervical cancer. County-level sociodemographic factors, including population diversity, metropolitan status, educational attainment, and household income, were also correlated with outcomes across all cancer types. Targeting PCP supply and education in lower density counties may improve population-based care for cervical cancer.

Enrollment of Individuals From Racial and Ethnic Minority Groups in Gynecologic Cancer Precision Oncology Trials.

To characterize whether enrollment patterns in precision oncology clinical trials for gynecologic cancers reflect the racial and ethnic diversity of patients with gynecologic cancers in the United States. ClinicalTrials.gov was queried to perform this cross-sectional review. We included precision oncology trials -defined as trials using molecular profiling of a tumor or the patient genome to identify targetable alterations to guide treatment-of ovarian, uterine, cervical, and vulvar cancers in the United States. National Cancer Institute Surveillance, Epidemiology, and End Results and United States Census Bureau data were used to estimate cancer burden and the expected number of trial participants by race and ethnicity for each gynecologic cancer. The ratio of actual-to-expected participants was calculated. A ratio greater than 1 signified overenrollment. A random effects meta-analysis was performed to assess the relative weights of individual trials. We identified 493 trials, 61 of which met inclusion criteria. There were 2,573 patients enrolled in ovarian cancer trials, 1,197 in uterine cancer trials and 162 in cervical cancer trials. Non-Hispanic White women were overrepresented overall (enrollment ratio 1.26, 95% CI 1.20-1.32) and across all cancer types on subgroup analysis. Asian women, non-Hispanic Black women, and Hispanic women were underrepresented overall (enrollment ratios 0.63, 95% CI 0.41-0.86; 0.51, 95% CI 0.36-0.66 and 0.30, 95% CI 0.23-0.36, respectively). In subgroup analyses, Asian women and non-Hispanic Black women were underrepresented in ovarian and uterine cancer trials and Hispanic women were underrepresented across all cancer types. Non-Hispanic Black women, Asian women, and Hispanic women with gynecologic cancers are underrepresented in precision oncology trials. Few U.S.-based precision oncology trials exist for uterine and cervical cancers, which have a high burden of morbidity and mortality among racial and ethnic minority groups. Failure to equitably enroll patients who belong to racial and ethnic minority groups may perpetuate existing disparities in gynecologic cancer outcomes.

Impact of Physician Densities on Gynecologic Cancer Outcomes in the United States [A316

Impact of Physician Densities on Gynecologic Cancer Outcomes in the United States [A316

The Impact of living in a food desert on endometrial cancer outcomes

The Impact of living in a food desert on endometrial cancer outcomes

Looking at cancer health disparities in gynecologic oncology in 2020.

To summarize the most recent evidence on gynecologic cancer disparities and to describe studies investigating the social determinants of health and receipt of evidence-based care and potential interventions to address inequities in care. Significant disparities in disease-specific survival by race/ethnicity, socioeconomic status, and payer status have persisted in women with gynecologic cancers. Compared with white women, black women have an increased likelihood of disease-specific mortality for endometrial cancer and are less likely to receive guideline-adherent care for ovarian cancer. The Covid-19 pandemic has brought significant attention to the structural barriers that contribute to persistent health disparities and how community-based partnerships with a focus on policy interventions are needed for equitable gynecologic cancer outcomes. In this review, we discuss structural barriers contributing to racial inequities, the role of Medicaid payer status and receipt of quality cancer care, gender, and racial workforce diversity, and community-based partnerships to create evidence-based interventions to address disparities.

The Microbiome and Gynecologic Cancer: Current Evidence and Future Opportunities.

We review the emerging evidence regarding the relationship between the microbiota of the gastrointestinal and female reproductive tracts and gynecologic cancer. The microbiome has essential roles in maintaining health. In recent years, the microbiota of the gastrointestinal and female reproductive tracts have been linked to many diseases, including gynecologic cancer. Alterations to the bacterial populations in a microbiota, or dysbiosis, have been shown to favor a pro-carcinogenic state through altered immune responses, dysregulated hormone metabolism, and modulation of the cell cycle. Pre-clinical and clinical studies have emerged, demonstrating that specific bacteria or microbial communities may be associated with increased risk for uterine, ovarian, and cervical cancers. Notably, numerous studies have linked a non-Lactobacillus-dominant vaginal microbiota, composed of anaerobic bacteria, with HPV infection, persistence, and development of invasive cervical cancer. Similarly, next-generation high-throughput sequencing techniques have enabled the characterization of unique microbiotas in patients with malignant and benign gynecologic conditions, shedding light on new associations between bacterial species and gynecologic cancers. Harnessing the power of the microbiome for early diagnosis, therapeutic intervention and modulation creates tremendous potential to optimize gynecologic cancer outcomes in the future.

The impact of state Medicaid expansion on patients with cervical cancer

Objective: The Medicaid expansion component of the Patient Protection and Affordable Care Act (ACA) allowed low-income Americans to gain insurance coverage. Little is known about how this policy specifically affects gynecologic cancer outcomes. We sought to determine the impact of state Medicaid expansion status on women with cervical cancer by examining the rates of insurance coverage at time of diagnosis, stage at presentation, as well as delays in and receipt of curative intent treatment.

A Review of Gynecologic Oncology in the Global Setting: Educating and Training the Next Generation of Women's Health Providers.

Women in low- and middle-income countries (LMICs) are responsible for the stability of their families. Child survival is directly linked to the health and well-being of their mother. Cancer is the leading cause of morbidity and mortality worldwide, and the incidence and mortality for women from cancer are projected to increase over the coming decades. Gynecologic cancer outcomes are improved when women are cared for by a gynecologic oncologist; however, there are limited specialized providers in LMICs. Increasing interest and involvement from specialists in the United States will improve partnerships abroad and the care of women worldwide. To summarize the importance of global gynecologic oncology care and the current data for US trainees in obstetrics and gynecology to participate in clinical and capacity-building opportunities. We performed a PubMed literature search for articles pertaining to the topic of global health education in obstetrics and gynecology and gynecologic oncology specifically. Many obstetric and gynecologic residency programs offer international opportunities, but these are less than those in other specialties and are more frequently focused in obstetrics. Many gynecologic oncology fellowship programs offer international experiences for fellows; however, the time and resources required are limited. Several US and international programs are ongoing to improve capacity building for gynecologic oncology in LMICs with local trainees. Training and care in gynecologic oncology care worldwide are improving through efforts at multiple levels. Continued efforts are needed to improve US trainee international education and experience.

Remote location interstitial brachytherapy with patient stabilization and subsequent transport to an outpatient center for treatment is safe and effective for the treatment of gynecologic malignancies

PurposeInterstitial brachytherapy is an essential component of definitive treatment for locally advanced gynecological malignancies. Although many outpatient centers are capable of delivering the radiation component of brachytherapy, they are not associated with an operative center for implant placement, limiting the ability to deliver appropriate care. In this study, we report on our experience with noncolocated implant placement and radiation delivery, and the impact of patient stabilization improvements on patient safety. Methods and MaterialsBetween 9/2010 and 11/2014, 25 patients with gynecologic malignancy underwent interstitial implantation and subsequent transport for high-dose-rate brachytherapy treatment. From 9/2010 to 10/2012, patients were transported using a standard ambulance stretcher; from 11/2012 to 11/2014, patients were placed on a patient positioning board or a WAFFLE support. Potential transport-associated toxicity was assessed, and the association between standard and augmented transport types and toxicity was analyzed. ResultsA total of 234 transports were performed. Median cost of transport was $150 per transport. There were 14 (10 patients) potential transportation-associated toxicities, including two lacerations/local trauma, three infections, and nine ulcers. There were 6 Grade 3 toxicities, all in the standard group. There was no association between stretcher type and laceration or ulcers, but enhanced support was associated with fewer overall toxicities, Grade 3 toxicities, and infections. ConclusionsNoncolocated implantation and treatment is safe and facilitates optimal therapy. Toxicities potentially associated with transport are minimal and seem to be reduced by augmented stabilization. Understanding that this is a reasonable way to deliver brachytherapy may allow more stand-alone centers to deliver high-quality care for patients and improve gynecologic cancer outcomes in the United States.

A5161 - Does bariatric surgery impact gynecologic cancer outcomes?

Obesity is an established risk factor for many cancers and is thought to adversely affect disease outcomes. Alterations in estrogen and other hormone metabolism in the obese have been postulated to increase the risk of gynecologic malignancies, including uterine and ovarian cancers. The impact of significant and sustained weight loss as achieved by bariatric surgery on gynecologic cancers is not well understood.

Gynecologic cancer outcomes in the elderly poor: A population-based study.

Adults aged ≥65 years who are dually enrolled in Medicare and Medicaid are an at-risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown. The current study was a population-based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar/vaginal cancers (2003-2009), with linked enrollment in Medicare and state Medicaid. Outcomes of all-cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves. Of 4522 women aged ≥65 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar/vaginal (8%) cancers. Dual enrollees had increased all-cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19-1.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02-1.47]; ovarian: aHR, 1.25 [95% CI, 1.05-1.49]; cervical: aHR, 1.34 [95% CI, 0.96-1.87]; and vulvar/vaginal: aHR, 1.93 [95% CI, 1.36-2.72]). Increased odds of advanced-stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06-1.79). Stratified survival curves demonstrated the strongest disparities among women with early-stage uterine and early-stage vulvar/vaginal cancers. Women aged ≥65 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all-cause mortality after diagnosis with a gynecologic cancer compared with the non-dually enrolled Medicare population. Women with early-stage uterine and vulvar/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions.

Gynecologic cancer outcomes in the elderly poor: A population-based study

Gynecologic cancer outcomes in the elderly poor: A population-based study

Gynecologic cancer outcomes of Medicare's elderly poor: A population-based study of North Carolina.

290 Background: Women ≥ 65 years dually enrolled in Medicare and Medicaid (‘Duals’) represent an at-risk group in cancer care, yet their outcomes across the spectrum of gynecologic cancers have not been studied. Our goal was to compare the association of insurance type to stage at diagnosis and mortality of older women after a gynecologic cancer diagnosis. Methods: Population-based, retrospective cohort study of women ≥ 65 years, diagnosed with gynecologic cancers from 2003 – 2009 in North Carolina Central Cancer Registry files. Medicare, Medicaid, and claims from privately insured health plans were linked with census data. Multiple logistic regression, Cox proportional hazard models, and Kaplan Meier survival curves were constructed comparing Medicare, Medicare HMO, and Medicare/Medicaid populations. Results: Among 4,554 patients in the cohort, 3,403 (74%) Medicare+/- supplemental private, 531(11%) Medicare HMO, and 620 (14%) Medicare + Medicaid (Dual). There were 2,215(49%) cases of early stage disease and 1,447(32%) deaths. Dual enrollees had increased mortality rates vs. Medicare overall (HR 1.61, 95%CI:1.4–1.8), and within each cancer site: uterine HR 1.50 (95%CI:1.2-1.9); ovarian HR 1.46 (95%CI:1.1-1.9); cervical HR 1.54 (95%CI:1.0–2.3); and vulvar/vaginal HR 2.84 (95%CI:1.9–4.2). Duals also had increased odds of advanced stage diagnosis in uterine cancer (OR 1.48, 95%CI:1.1–2.0). Stratified survival curves demonstrate the largest disparities amongst women with early stage uterine, advanced stage ovarian, and early stage vulvar/vaginal cancers. Conclusions: Dually enrolled gynecologic cancer patients have a 60% increased mortality rate compared to non-duals despite equivalent stage distribution at the time of diagnosis. Specific site/stage subgroups drive these results and should be the focus of future studies elucidating mediators of these disparate outcomes, including barriers in access to specialty surgical care.

Is bariatric surgery an option for women with gynecologic cancer? Examining weight loss counseling practices and training among gynecologic oncology providers

ObjectiveThe objective of this study was to evaluate gynecologic oncology provider (GOP) practices regarding weight loss (WL) counseling, and to assess their willingness to initiate weight loss interventions, specifically bariatric surgery (WLS). MethodsMembers of the Society of Gynecologic Oncology were invited to complete an online survey of 49 items assessing knowledge, attitudes, and behaviors related to WL counseling. ResultsA total of 454 participants initiated the survey, yielding a response rate of 30%. The majority of respondents (85%) were practicing GOP or fellows. A majority of responders reported that >50% of their patient population is clinically obese (BMI≥30). Only 10% reported having any formal training in WL counseling, most often in medical school or residency. Providers who feel adequate about WL counseling were more likely to offer multiple WL options to their patients (p<.05). Over 90% of responders believe that WLS is an effective WL option and is more effective than self-directed diet and medical management of obesity. Providers who were more comfortable with WL counseling were significantly more likely to recommend WLS (p<.01). Approximately 75% of respondents expressed interest in clinical trials evaluating WLS in obese cancer survivors. ConclusionsThe present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS.

Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers

BackgroundRisk-reducing salpingo-oophorectomy (RRSO) is widely used by carriers of BRCA1 or BRCA2 (BRCA1/2) mutations to reduce their risks of breast and ovarian cancer. To guide women and their clinicians in optimizing cancer prevention strategies, we summarized the magnitude of the risk reductions in women with BRCA1/2 mutations who have undergone RRSO compared with those who have not.MethodsAll reports of RRSO and breast and/or ovarian or fallopian tube cancer in BRCA1/2 mutation carriers published between 1999 and 2007 were obtained from a PubMed search. Hazard ratio (HR) estimates were identified directly from the original articles. Pooled results were computed from nonoverlapping studies by fixed-effects meta-analysis.ResultsTen studies investigated breast or gynecologic cancer outcomes in BRCA1/2 mutation carriers who had undergone RRSO. Breast cancer outcomes were investigated in three nonoverlapping studies of BRCA1/2 mutation carriers, four of BRCA1 mutation carriers, and three of BRCA2 mutation carriers. Gynecologic cancer outcomes were investigated in three nonoverlapping studies of BRCA1/2 mutation carriers and one of BRCA1 mutation carriers. RRSO was associated with a statistically significant reduction in risk of breast cancer in BRCA1/2 mutation carriers (HR = 0.49; 95% confidence interval [CI] = 0.37 to 0.65). Similar risk reductions were observed in BRCA1 mutation carriers (HR = 0.47; 95% CI = 0.35 to 0.64) and in BRCA2 mutation carriers (HR = 0.47; 95% CI = 0.26 to 0.84). RRSO was also associated with a statistically significant reduction in the risk of BRCA1/2-associated ovarian or fallopian tube cancer (HR = 0.21; 95% CI = 0.12 to 0.39). Data were insufficient to obtain separate estimates for ovarian or fallopian tube cancer risk reduction with RRSO in BRCA1 or BRCA2 mutation carriers.ConclusionThe summary estimates presented here indicate that RRSO is strongly associated with reductions in the risk of breast, ovarian, and fallopian tube cancers and should provide guidance to women in planning cancer risk reduction strategies.

Are There Regional Differences in Gynecologic Cancer Outcomes in the Context of a Single-payer, Publicly-funded Health Care System?

Abstract Background: Canada has a single-payer, publicly-funded health care system that provides comprehensive health care, and therefore significant disparities in health outcomes are not expected in our population. The objective of this study was to determine if differences exist in endometrial cancer outcomes across regions in Ontario. Methods: This was a population-based study of all endometrial (uterine) cancer cases diagnosed from 1996 to 2000 in Ontario and linked to various administrative databases. Univariate analyses examined trends in demographics (age, income, co-morbidities), treatment (surgical staging and adjuvant pelvic radiotherapy), and pathology (grade, histology, stage) across 14 geographic regions defined by local health integration networks (LHINs) in Ontario. Primary outcome was 5-year overall survival among LHINs, which were compared in a multilevel Cox regression model to account for clustering of patient data at the hospital level. Results: There were 3,875 evaluable cases with complete information on demographics, treatment, pathology, and outcomes. There was significant variation in patient demographics, treatment, and pathology across the 14 LHINs. Low income level and surgery at a low-volume, community hospital without gynecologic oncologists were not associated with a higher risk of death. There was a trend towards clustering of patients within hospitals. After adjustment for covariates, there was no significant difference in survival across LHINs. Conclusions: In the context of a single-payer, publicly-funded health care system, we did not find significant regional differences in endometrial cancer outcomes. Key words: Endometrial neoplasms; local health integration networks (LHINs); delivery of health care; outcome assessment Resume Contexte : Puisque le Canada est dote d’un regime public de soins de sante a payeur unique qui offre toute la gamme des soins, on ne s’attend pas a observer de disparites importantes dans les resultats cliniques de la population. Notre etude visait a determiner l’existence d’ecarts regionaux dans les resultats des cancers de l’endometre en Ontario. Methode : Il s’agissait d’une etude representative de tous les cas de cancer de l’endometre (uterus) diagnostiques entre 1996 et 2000 en Ontario et lies a diverses bases de donnees administratives. Des analyses univariees ont permis de degager des tendances concernant le profil demographique (âge, revenu, comorbidites), le traitement (stadification par chirurgie et radiotherapie pelvienne adjuvante) et la pathologie (degre, histologie, stade) dans les 14 regions geographiques definies par les reseaux locaux d’integration des services de sante (RLISS) de l’Ontario. Le principal resultat etait la survie globale de 5 ans dans les divers RLISS, que nous avons compares a l’aide d’un modele de regression de Cox multiniveau pour tenir compte de la concentration des donnees des patientes dans les hopitaux. Resultats : Nous avons trouve 3 875 cas evaluables pour lesquels il existait des donnees completes (sur le profil demographique, le traitement, la pathologie et les resultats). Le profil demographique des patientes, le traitement et la pathologie variaient de facon significative dans les 14 RLISS. Les faibles niveaux de revenu et les chirurgies dans les petits hopitaux communautaires sans gynecologue oncologue n’etaient toutefois pas associes a un risque de deces plus eleve. Nous avons observe une tendance a la concentration des cas a l’interieur des hopitaux. Compte tenu des covariables, il n’y avait pas d’ecart significatif dans les taux de survie d’un RLISS a l’autre. Conclusion : Dans le contexte d’un regime public de soins de sante a payeur unique, nous n’avons constate aucune difference regionale significative dans les resultats des cas de cancer de l’endometre. Mots cles : tumeurs de l’endometre; reseaux locaux d’integration des services de sante (RLISS); prestation des soins de sante; evaluation des resultats

Reduced cancer risks in oral contraceptive users: Results from the Women's Health Initiative

Female hormone use has recently come under intense scrutiny. To date, reports on the relationships between oral contraceptive use and subsequent cancer development have demonstrated conflicting results. Thus, we sought to determine the relationship and predictive value of oral contraceptive use for gynecologic cancer outcomes in a large population of well-defined users.