This is part 2 of our 3 part series on diversity in obstetrics. Part 1 can be found here. Part 3 can be found here.
According to a recent study in Obstetrics & Gynecology, there are racial disparities in the timeliness of endometrial cancer care.
Takeaways
- Impact of Early Detection: Early detection of endometrial cancer is crucial, as it significantly reduces 5-year mortality rates.
- Pathway to Treatment Model: The Walter et al Pathway to Treatment model, which includes the appraisal interval, help-seeking interval, diagnostic interval, and pretreatment interval, can be used to identify reasons for delays in cancer care.
- Awareness and Knowledge Gaps: There is a gap in awareness and knowledge related to endometrial cancer symptoms, risk factors, and screening options among different populations.
- Motivation for Seeking Care: While there was no significant association found between race and the willingness to seek care for endometrial cancer, the study highlighted that symptom duration and pain were significant factors impacting motivation for seeking care.
- Racial Disparities in Timeliness: The study found that Black patients were significantly less likely to receive guideline-concordant evaluations for endometrial cancer compared to White patients. Significant pretreatment delays were observed for Black patients and those of other races compared to White patients.
Endometrial cancer, the most common gynecologic cancer in the United States, is more prevalent with increased age and obesity status. Of factors associated with endometrial cancer, only stage is modifiable, with a 50% decrease in 5-year mortality for early-stage vs late-stage disease.
Factors associated with advanced endometrial cancer stage include lower median family income, lower neighborhood socioeconomics, and less insurance coverage. However, little action has been taken to reduce endometrial cancer stage in the United States.
The Walter et al Pathway to Treatment model can be used to determine reasons cancer care may be delayed. Thismodel is comprised of the appraisal interval, help-seeking interval, diagnostic interval, and pretreatment interval. Investigators conducted a review to determine disparities in the timeliness of the Pathway to Treatment of endometrial cancer.
Literature about the 4 intervals of the Pathway to Treatment model was found through structured searches of electronic databases such as EMBASE, PubMed, ClinicalTrials.gov, Scopus, and Cochrane Central Register of Controlled Trials databases. Secondary sources were found through a search of Google Scholar.
Titles and abstracts were screened by 2 independent researchers for eligibility, while full texts were screened for inclusion. Inclusion criteria included assessing marginalized populations able to develop endometrial cancer and variables in the Walter et al Pathway to Treatment Model pertaining to endometrial cancer.
All studies were observational, with 10 being retrospective cohort studies, 11 cross-sectional, and 3 qualitative. The appraisal interval was evaluated in 10 studies, the help-seeking interval in 5, the diagnostic interval in 5, and the pretreatment interval in 10.
Awareness of abnormal or postmenopausal bleeding as symptoms of endometrial cancer were reported by 72.7% to 95.4% of participants. In studies of endometrial cancer survivors, 38% to 44.4% were aware obesity was a risk factor for endometrial cancer, compared to 20.7% to 47.9% of studies without endometrial cancer survivors.
Knowledge on screening options for patients with genetic predispositions to endometrial cancer ranged from 29.2% to 48.2%, while awareness that cervical cancer screening does not assess endometrial cancer was up to 74.6%. Interventions for improving health literacy for gynecologic cancer were reported as effective.
An association was not found between race and willingness to seek care for endometrial cancer. Symptom duration and pain were significant factors impacting motivation for seeking care. However, Black patients were significantly less likely to receive a guideline-concordant evaluation for endometrial cancer compared to White patients.
Significant pretreatment delays were observed based on race, with Black patients having to wait 3 to 5 more days than White patients. Patients with a race other than Black or White also had a longer wait than White patients. Non-Hispanic Black patients had a 30% to 40% increased risk of waiting more than 6 weeks for surgery, vs a 20% to 40% increase for Hispanic or Asian patients.
These results indicated a correlation between race and the timeliness of endometrial cancer care. Investigators recommended future studies evaluate interventions for populations at risk of Pathway to Treatment delays.
Reference
Najor A, Melson V, Lyu J, et al. Disparities in timeliness of endometrial cancer care: ascoping review. Obstet Gynecol. 2023;142(4):967-977. doi:10.1097/AOG.0000000000005338
