Disparities in receipt of care for high-grade endometrial cancer: A National Cancer Data Base analysis

Gynecol Oncol. 2017 Apr;145(1):114-121. doi: 10.1016/j.ygyno.2017.01.024. Epub 2017 Feb 1.


Purpose: To examine patterns of care and survival for Hispanic women compared to white and African American women with high-grade endometrial cancer.

Methods: We utilized the National Cancer Data Base (NCDB) to identify women diagnosed with uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear cell carcinoma and papillary serous carcinoma between 2003 and 2011. The effect of treatment on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.

Results: 43,950 women were eligible. African American and Hispanic women had higher rates of stage III and IV disease compared to white women (36.5% vs. 36% vs. 33.5%, p<0.001). African American women were less likely to undergo surgical treatment for their cancer (85.2% vs. 89.8% vs. 87.5%, p<0.001) and were more likely to receive chemotherapy (36.8% vs. 32.4% vs. 32%, p<0.001) compared to white and Hispanic women. Over the entire study period, after adjusting for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, African American women had lower overall survival compared to white women (Hazard Ratio 1.21, 95% CI 1.16-1.26). Conversely, Hispanic women had improved overall survival compared to white women after controlling for the aforementioned factors (HR 0.87, 95% CI 0.80-0.93).

Conclusions: Among women with high-grade endometrial cancer, African American women have lower all-cause survival while Hispanic women have higher all-cause survival compared to white women after controlling for treatment, sociodemographic, comorbidity and histopathologic variables.

MeSH terms

  • Adenocarcinoma, Clear Cell / mortality
  • Adenocarcinoma, Clear Cell / pathology
  • Adenocarcinoma, Clear Cell / therapy*
  • Adenocarcinoma, Papillary / mortality
  • Adenocarcinoma, Papillary / pathology
  • Adenocarcinoma, Papillary / therapy
  • Aged
  • Black or African American / statistics & numerical data
  • Carcinoma, Endometrioid / mortality
  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / therapy*
  • Carcinosarcoma / mortality
  • Carcinosarcoma / pathology
  • Carcinosarcoma / therapy*
  • Cause of Death
  • Chemotherapy, Adjuvant / statistics & numerical data*
  • Comorbidity
  • Databases, Factual
  • Education
  • Endometrial Neoplasms / mortality
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / therapy*
  • Ethnicity / statistics & numerical data*
  • Female
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Hysterectomy / statistics & numerical data*
  • Insurance Coverage
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Neoplasms, Cystic, Mucinous, and Serous / mortality
  • Neoplasms, Cystic, Mucinous, and Serous / pathology
  • Neoplasms, Cystic, Mucinous, and Serous / therapy
  • Proportional Hazards Models
  • Retrospective Studies
  • Social Class
  • Survival Rate
  • United States
  • White People / statistics & numerical data