Abstract IA010: Neighborhood socioeconomic status and outcomes of patients with endometrial cancer
Authors: Gamble Charlotte 
Published: March 2024

Abstract
Cancer disparities manifest a particularly intricate interplay between incompletely understood genomic risks, biologic susceptibility, and access to quality care. Disparate access to quality cancer care is often a reflection of a complex relationship between social, historical, and environmental factors that influence a patient’s surroundings, however large observational studies rarely quantify these contextual elements beyond individual or area-level income and education. The well-established racial and socioeconomic inequities in uterine cancer outcomes remain one of the widest amongst all cancer types, with an approximate 20% difference in 5-year survival between Black and White patients, which remains unchanged over the past 15 years. Racial disparities persist even when controlling for more advanced stage at presentation, the occurrence of more aggressive tumor subtypes and quality of treatment. When controlling for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, African American patients still have lower overall survival than White patients (HR 1.21, 95% CI 1.16-1.26). There continues to be a concerted call for further explanation of the socioeconomic factors that contribute to these racial disparities. To date, few epidemiologic studies of uterine cancer have utilized markers that are more representative of the complex interplay of various social and environmental factors that influence health outcomes. Some studies have examined area level poverty and uterine cancer treatment and outcomes, finding that living in more vulnerable neighborhoods was associated with poor survival, delays in care, and inadequate treatment. However, these studies do not take into account the interplay of neighborhood poverty and how race, or experience of racism, may affect this relationship. Given the complex and insidious nature of racism in the United States, we have further explored how neighborhood poverty may affect uterine cancer outcomes taking into account the race of patients studied. Preliminary data from New York state suggests that neighborhood socioeconomic vulnerability is associated with worse treatment and survival for patients with uterine cancer, and this was best seen in White patients living outside of major metropolitan areas. The greatest Black/White survival disparities are seen in the wealthiest neighborhoods in New York City. Black women with advanced stage endometrial cancer living in affluent areas have no significant survival advantage over those living in vulnerable neighborhoods.
Citation Format: Charlotte Gamble. Neighborhood socioeconomic status and outcomes of patients with endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr IA010.