Abstract 3726: Race-based disparities in loss of functional independence after uterine cancer
Authors: Dean Lorraine , Zhang Xiaochen , Latif Nawar , Haggerty Ashley , Giuntoli Robert , Kim Sarah , Shalowitz David , Stashwick Caitlin , Morgan Mark , Ko Emily , Schmitz Kathryn 
Published: August 2015

Introduction

Racial disparities in uterine cancer-related outcomes have been reported. Black uterine cancer patients are more likely to have worse clinical outcomes, which are not fully explained by number of comorbidities. Few studies have investigated the factors that may influence functional independence following surgery for uterine cancer. The goal of this study was to determine if race, preoperative body mass index (BMI) and medical comorbidities are predictors of loss of functional independence.

Method:

Data from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were used. All patients were identified by post-operative ICD-9 code. Functional independence was defined as: the patient not requiring assistance from another person for any activities of daily living preoperatively. Loss of independence was defined as requiring discharge to a post-care facility or death, in the immediate postoperative period following hysterectomy. Demographic factors, comorbidities, BMI, intraoperative and postoperative outcomes and discharge status were captured within 30 days of surgery. Statistical analyses included multivariate logistic regression and Wald tests for interaction.

Results:

4115 patients were identified with a diagnosis of uterine cancer and were functionally independent preoperatively: 310 (7.5%) were Black and 3805 (92.5%) were non-black. Compared with non-black, Black uterine cancer patients were notable for greater BMI (median 35.4 vs. 32.3, P&lt;0.001), more likely to have one or more comorbidities (76.9% vs. 59.8%, P&lt;0.001), and longer operative time (179.9 mins vs. 159.5 mins, P&lt;0.001). After adjusting for BMI, age, number of comorbidities, pre-operative conditions, major complications, disseminated cancer and days of hospitalization prior to surgery, Black women were not significantly more likely to lose functional independence during the postoperative period than non-Black women. However, a significant interaction (OR 1.14 per 1-unit BMI increase, P&lt;0.001) was found between Black and BMI on loss of functional independence. Interaction plots revealed worse functional outcomes per unit increase in BMI for Black women but not in non-Blacks.

Conclusions:

The significant interaction between Black race and BMI suggests a 14% increased odds of losing functional independence for each unit of BMI increase for Black uterine cancer patients, meaning that a 10-point increase in BMI would confer a 140% increase in odds of losing functional independence. Black uterine cancer patients with high BMIs may especially benefit from weight loss or interventions to optimize physical function and comorbidity profiles prior to and following surgery, in order to reduce the likelihood of losing functional independence after surgery. Together these efforts may improve disease specific as well as overall health outcomes in Black women with uterine cancer.

Citation Format: Lorraine Dean, Xiaochen Zhang, Nawar Latif, Ashley Haggerty, Robert Giuntoli, Sarah Kim, David Shalowitz, Caitlin Stashwick, Mark Morgan, Emily Ko, Kathryn Schmitz. Race-based disparities in loss of functional independence after uterine cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3726. doi:10.1158/1538-7445.AM2015-3726