title: Disparities in treatment and survival for women with endometrial cancer: A contemporary national cancer database registry analysis.
abstract: The study aim was to identify contemporary socioeconomic, racial, ethnic, and facility-related factors associated with stage at diagnosis, receipt of cancer treatment, and survival in women with endometrial cancer (EC).
  
  
  
  Women diagnosed with EC between 1998 and 2010 were identified from the National Cancer Database. Variables associated with the outcomes of interest were assessed using multivariable Cox proportional hazards and logistic regression.
  
  
  
  Among 228,511 women identified, the percentage of blacks with stage IIIC/IV disease at diagnosis was nearly twice that of non-Hispanic whites (17.8% vs 9.8%; P<0.001). Patients with advanced disease who were insured with Medicare were less likely to receive standard-of-care postoperative radiotherapy and/or chemotherapy than those with private insurance (odds ratio: OR 0.80, P<0.001), as were those residing in the South (reference) in comparison to the Northeast, Atlantic, Great Lakes, and Midwest regions (OR 1.3-1.7, all P<0.001). Those residing in the Mountain region were even less likely to receive appropriate treatment (OR 0.7, P<0.001). Five-year stage IIIC/IV survival was 42.8% for non-Hispanic whites vs 24.6% for blacks (hazard ratio 1.3, P<0.001). Other factors associated with inferior 5-year survival included payer status (not insured, Medicaid, Medicare, vs private, ORs 1.2-1.3, all P<0.01), and treatment at low-volume centers (<5 vs ≥30cases/year, HR 1.3, P<0.001).
  
  
  
  Socioeconomic, geographic and facility-related factors predict advanced endometrial cancer stage, failure to receive cancer care, and shorter survival. Black women had especially poor survival. Nationwide standardization and concentration of treatment at high-volume centers may improve outcomes.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, United States.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Fader
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research Division of Surgery Research, Mayo Clinic, Rochester, MN, United States.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research Division of Surgery Research, Mayo Clinic, Rochester, MN, United States.
authors.forename: Kristine T
authors.initials: KT
authors.lastname: Hanson
authors.affiliation: Division of Gynecologic Oncology, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Jeff F
authors.initials: JF
authors.lastname: Lin
authors.affiliation: Florida Gynecologic Oncology, Fort Myers, FL, United States.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Grendys
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research Division of Surgery Research, Mayo Clinic, Rochester, MN, United States; Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: dowdy.sean@mayo.edu.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries
keywords: Disparities; Endometrial cancer; Survival