Surgical wait time: A new health indicator in women with endometrial cancer

• Published in: Gynecologic oncology 2016-06, Vol.141 (3), p.511-515
• Main Authors: Strohl, Anna E, Feinglass, Joseph M, Shahabi, Shohreh, Simon, Melissa A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Endometrioid - economics; Carcinoma, Endometrioid - ethnology; Carcinoma, Endometrioid - surgery; Delayed treatment; Endometrial cancer; Endometrial Neoplasms - economics; Endometrial Neoplasms - ethnology; Endometrial Neoplasms - mortality; Endometrial Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Insurance, Health - statistics & numerical data; Middle Aged; Minority Groups - statistics & numerical data; Obstetrics and Gynecology; Proportional Hazards Models; Socioeconomic Factors; Surgical wait time; Time-to-Treatment - statistics & numerical data; United States - epidemiology
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2016.04.014

Abstract Objective To evaluate factors associated with delayed surgical treatment among women with endometrial cancer. Methods Using the National Cancer Database (NCDB), we analyzed time to first surgery for epithelial endometrial cancer patients who underwent surgical treatment from 2003 to 2011. Poisson regression was used to examine delays > 6 weeks between diagnosis and surgery, controlled for patients' sociodemographic and clinical characteristics. Survival for women diagnosed between 2003 and 2006 with timely versus delayed surgery was compared using Cox proportional hazards regression. Results The study included 112,041 women diagnosed at 1108 continuously reporting NCDB hospitals. Survival through 2011 was available for 40,184 women. All patients underwent hysterectomy. Twenty-eight percent of patients underwent surgery > 6 weeks after diagnosis. Poisson regression estimates indicated that being younger than 40 years old, being black or Hispanic, having Medicaid or being uninsured, or being from the lowest education quartile were associated with a significantly higher likelihood of surgical wait time > 6 weeks. Patients diagnosed in 2010–2011 were more likely (IRR 1.32, 95% CI 1.24–1.40) to undergo surgery > 6 weeks after diagnosis compared to patients treated in 2003. Survival for women with surgical wait times > 6 weeks was worse than those treated within 6 weeks of diagnosis (HR 1.14, 95% CI 1.09–1.20). Conclusions Being a minority patient and having lower socioeconomic status or poor insurance coverage were associated with an increased likelihood of delayed surgical treatment. Wait times > 6 weeks from diagnosis of endometrial cancer to definitive surgery may have a negative impact on survival.