Time to surgery linked to survival among women with high-grade endometrial cancer
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Regionalization of care for high-grade endometrial cancer in Ontario had no negative effect on surgical wait times, according to findings presented at the virtual Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.
However, women who waited more than 45 days between initial gynecologic oncology consultation and surgery had significantly poorer outcomes, results showed.
“These patients were also significantly more likely to be of lower socioeconomic status, and less likely to undergo surgical staging or to receive adjuvant treatment,” Andra Nica, MD, MSc, FRCSC, of University of Toronto, said during a presentation. “A greater emphasis should be placed on strategies to improve equitable and timely access to health care.”
Extended wait times for cancer surgery are associated with poorer prognosis and increased psychological distress. Wait times have increased steadily in the United States and Canada, and the COVID-19 pandemic has contributed to this trend, according to study background.
Cancer Care Ontario released practice guidelines in June 2013 that advocated for the regionalization of endometrial cancer surgery to gynecologic oncologists who practice in designated centers.
After this guidance, concern arose about the potential for increased wait times for hysterectomy; however, the association between wait time to surgery and patient outcomes remained unclear.
Nica and colleagues aimed to determine the impact of care regionalization for high-grade endometrial cancer on surgical wait times. They also assessed the association between longer wait time for surgery and survival.
The researchers used population-based administrative provincial data sources to identify 3,518 women diagnosed with non-endometrioid high-grade endometrial cancer between June 2003 and March 2017. The population included women with serous (n = 1,316), carcinosarcoma (n = 787), clear cell (n = 249) or other (n = 1,166) disease.
Researchers divided women based on two time periods — before January 2014 (n = 2,426) or after (n = 1,092) — to allow 6 months for increased knowledge of the regionalization guideline after publication.
Researchers used multivariable Cox proportional hazards regression with spline function to assess the association between wait time and OS as calculated from time of surgery to death of any cause.
Median wait time from diagnosis to surgery did not change significantly between the pre-regionalization period (50 days; interquartile range, 30-71) and post-regionalization period (52 days; interquartile range, 37-67).
Among women who underwent surgery with a gynecologic oncologist, wait times from diagnosis to hysterectomy (59 days vs. 55 days; P = .0002) and from first gynecologic oncology consultation to hysterectomy (32 days vs. 29 days; P = .0006) declined from the pre-regionalization period to post-regionalization period.
Results revealed worse survival outcomes among women who waited more than 45 days from their first gynecologic oncology appointment to surgery (46-60 days vs. 29-45 days, HR for death = 1.19; 95% CI, 1.04-1.36; 61-75 days vs. 29-45 days, HR for death = 1.42; 95% CI, 1.11-1.83).
Women who waited more than 45 days were more likely than those who underwent surgery within 45 days to be of low income (45.2% vs. 36.3%). They also were less likely to have undergone surgical staging (62.7% vs. 71.5%), received adjuvant chemotherapy (37.8% vs. 48.8%) or undergone adjuvant radiation (44% vs. 52.1%).
Researchers reported shorter survival among women who had surgery within 14 days of diagnosis compared with those who had surgery with 29 to 45 days of diagnosis (HR for death = 1.94; 95% CI, 1.48-2.54), suggesting these women had more severe disease.
Other factors associated with higher risk for death included age (HR = 1.05; 95% CI, 1.04-1.05), disease stage (stage II vs. stage I, HR = 1.8; 95% CI, 1.42-2.28; stage III vs. stage I, HR = 3.05; 95% CI, 2.67-3.48; stage IV vs. stage I, HR = 6.18; 95% CI, 4.39-8.72) and Aggregated Diagnosis Group comorbidity score (10-32 vs. 0-9, HR = 1.12; 95% CI, 1.05-1.2).
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Nica A, et al. Abstract 11163. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (virtual meeting); March 19-25, 2021.
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