Abstract A129: Association of concordance with guidelines of the National Comprehensive Cancer Network and overall survival in Puerto Rican women with endometrial cancer
Authors: Pagan-Santana Yisel , Ortiz-Ortiz Karen J. , Castañeda-Avila Maira , Rios-Motta Ruth 
Published: December 2023

Abstract
Background: Endometrial cancer represents a significant burden in Puerto Rico, as it is one of the most common cancers among women. Although it has a favorable prognosis when diagnosed early, it remains the fifth leading cause of cancer-related deaths among women living in Puerto Rico. This highlights the need to address healthcare disparities and improve the quality of the healthcare system. Treatment guidelines are designed to assist healthcare professionals in offering the best possible care to patients by providing evidence-based suggestions. Implementing standardized practices is crucial to enhancing healthcare quality outcomes. Our objective was to assess the concordance of National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer treatment and its association with overall survival. Methods: Data on endometrial cancer patients aged 18 years and older diagnosed between 2009 and 2015 was obtained from the Puerto Rico Central Cancer Registry, linked to the Puerto Rico Health Insurance Administration database (n=2,114). The association between clinical aspects, health system, and socioeconomic factors with receipt of guideline-concordant treatment was evaluated using logistic regression. Overall survival (OS) was calculated using the Kaplan-Meier method. Univariate and multivariate-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between guideline-concordant treatment and OS. Results: In our cohort, 53.9% of patients received guideline-concordant treatment. Patients receiving treatment at a Commission on Cancer (CoC)-accredited facility are twice as likely to receive guideline-concordant treatment than non-accredited facilities (95% CI: 1.71-2.98). Individuals who received an assessment from a gynecologist oncologist are 90.0% more likely to receive treatment based on NCCN guidelines than those who did not (95% CI: 1.56-2.32). Private insured patients are 28.0% more likely to receive guideline-concordant treatment than Medicaid patients (95% CI: 1.02-1.61). In Cox regression models, guideline-concordant treatment was associated with a lower mortality risk compared to women who did not receive guideline-concordant treatment (95% CI: 0.59- 0.89). Conclusion: Receiving guideline-concordant treatment is a strong predictor of improved survival rates in endometrial cancer patients. Additionally, patients treated at CoC-accredited hospitals and by gynecologic oncologists tend to receive higher-quality care. Given that guidelines based on effective treatment standards have been demonstrated to enhance cancer patient outcomes, we must encourage and support factors contributing to their increased adoption. By doing so, we can strive to improve the prognosis and overall well-being of individuals affected by endometrial cancer in Puerto Rico.
Citation Format: Yisel Pagan-Santana, Karen J. Ortiz-Ortiz, Maira Castañeda-Avila, Ruth Rios-Motta. Association of concordance with guidelines of the National Comprehensive Cancer Network and overall survival in Puerto Rican women with endometrial cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A129.