Abstract A134: Minority women with non-endometrioid endometrial cancer are not less likely to receive guideline-concordant treatment than White women
Authors: Dholakia Jhalak , Reamer Elyse , Salani Ritu , Felix Ashley 
Published: September 2020

Abstract
Background: Black women with endometrial cancer (EC) experience significant disparities in treatment and survival. They undergo diagnostic evaluation, primary surgical management, and non-surgical treatment at statistically lower rates than non-Hispanic White (NHW) women. Black women are also more likely to present with advanced stage disease and aggressive tumor histology, including non-endometrioid EC subtypes, resulting in a 93% greater overall mortality rate than Whites. Research in other cancers show that Black patients receive guideline-concordant care less often than NHW women. To date, no study has assessed the relationship between race and receipt of comprehensive guideline-concordant therapy, nor have studies examined the impact of guideline- concordant treatment and survival according to race among women with EC. We investigated these associations among women diagnosed with non-endometrioid EC in the National Cancer Database. Methods: Our analysis included 21,696 NHW, 6,859 non-Hispanic Black (NHB), 1,752 Hispanic, and 922 Asian/Pacific Islander (AS/PI) women diagnosed with non-endometrioid EC between 2004 and 2014. We used year-specific National Comprehensive Cancer Network (NCCN) guidelines to classify treatment as guideline-concordant vs. not concordant. We used multivariable logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association between race and receipt of guideline-concordant treatment in models adjusted for age at diagnosis, stage, histology, comorbidity score, insurance type, and facility type. We used multivariable-adjusted Cox proportional hazards models to estimate hazards ratios (HRs) and 95% CIs for relationships between receipt of guideline-concordant treatment and overall survival stratified by race. Results: In the overall study population, 38.2% of women with non-endometrioid EC received NCCN guideline-concordant treatment. Compared to NHW women, NHB women (OR=1.05, 95% CI=0.99 to 1.11), Hispanic women (OR=1.10, 95% CI=0.99 to 1.23) and AS/PI women (OR=1.11, 95% CI=0.97 to 1.28) did not have significantly different odds of receiving guideline-concordant treatment in multivariable-adjusted models. Receipt of guideline-concordant treatment was significantly associated with improved survival among NHW (HR=0.84, 95% CI=0.80 to 0.87), NHB (HR=0.86, 95% CI=0.80 to 0.92), and Hispanic women (HR=0.85, 95% CI=0.72 to 1.00) but not among AS/PI women (HR=0.88, 95% CI=0.71 to 1.10). Conclusions: Almost two-thirds of women with non-endometrioid EC may not receive guideline-concordant treatment. We observed no difference in receipt of concordant care between racial groups. When received, guideline-concordant treatment was associated with improved survival in almost all racial groups. Therefore, instituting interventions to improve adherence to guideline-concordant treatment may contribute to reducing racial disparities in survival for women with non-endometrioid EC.
Citation Format: Jhalak Dholakia, Elyse Reamer, Ritu Salani, Ashley Felix. Minority women with non-endometrioid endometrial cancer are not less likely to receive guideline-concordant treatment than White women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A134.