Factors predicting treatment delays in endometrial cancer

Background: Women diagnosed with type I endometrial cancer have a favorable prognosis and are often cured with surgery alone when treated in a timely manner at an early stage. However, women who experience treatment delays experience worse survival rates, decreased quality of life, and higher medical costs. Certain patient factors such as Black or Hispanic race, higher body mass index (BMI), distance from specialty care, and non-commercial insurance may be associated with treatment delays. Aims: 1) To determine how many women treated for type I endometrial cancer at a gynecologic oncology practice in Salem, Oregon experience treatment delays of greater than 6 weeks, and 2) to examine which demographic variables are associated with greater than 6-week treatment delays. Methods: A retrospective cohort study using chart reviews was used to examine intervals from pathologic diagnosis to initiation of treatment among women treated for type I endometrial cancer at a gynecologic oncology clinic in Salem, Oregon between January 1, 2016 and December 31, 2017. Descriptive statistics (frequency, percent, mean, and standard deviation) were used to describe the sample and time interval from diagnosis to treatment. T-tests, [chi]2 or Mann Whitney U analysis was used to compare differences in treatment delays based on patient characteristics (e.g. age, BMI, distance from clinic, insurance type, marital status, race/ethnicity, grade of cancer). Logistic regression was used to further explore which participant characteristics were more likely to predict significant treatment delays. Data analysis: 197 participants were seen in the clinic for endometrial cancer in the clinic during the study period. Of those, 150 women met inclusion criteria. The mean age of participants was 63.7 years. The mean interval from diagnosis to treatment was 8.1 weeks, with 53.3% of the sample experiencing a delay of greater than six weeks (N = 80). In this sample, 88% identified as Caucasian (N = 132), 8% as Hispanic/Latino (N = 12), 1.33% as Black (N = 2), 2% as Asian (N = 3), and 0.67% as other (N = 1). Results from a t-test found women with treatment delays had a higher body mass index (BMI) (M = 38.9, SD = 11.5) than those with lower BMI (M = 34.9, SD = 9.8), t (148) = -2.29, p = 0.023. In addition, results from a [chi]2 test found that there was a difference in treatment delays by race/ethnicity [chi]2 (1, N = 150) = 7.40, p = 0.0065 and by grade of cancer [chi]2 (2, N = 150), p= 0.027. There were no significant differences in treatment delays based on primary or secondary insurance type, distance from clinic, or marital status. Logistic regression found that non-Caucasian race predicted increased risk for treatment delays (OR 5.15, 95% CI 1.4-18.6, p = 0.012). In addition, those with grade 1 cancer were 3 times more likely to experience treatment delays than women with grade 3 cancer (OR 3.0, 95% CI: 1.05 - 8.62, p = .04). Finally, logistic regression found that BMI was marginally predictive of treatment delays (OR 1.03, p = 0.08, 95% CI: 0.997-0.1.06). Conclusions: The findings of this project indicate that treatment delays among women with type 1 endometrial cancer occurred in over half of patients at the gynecologic oncology practice in Salem. Delays in this setting were more common than anticipated based on prior research. In addition, findings suggest that non-Caucasian women were more likely to experience treatment delays, and women with grade 1 cancer were more likely to experience treatment delays than women with grade 3 cancer during the study period. Finally, higher BMI was marginally predictive of treatment delays.