Advertisement

Patient characteristics and health system factors associated with adjuvant radiation therapy receipt in older women with early-stage endometrial cancer

  • Jihye Park
    Correspondence
    Corresponding author at.: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Mcgavran-Greenberg Hall, CB #7400, Chapel Hill, NC 27599, USA.
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
    Search for articles by this author
  • Jennifer L. Lund
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
    Search for articles by this author
  • Erin E. Kent
    Affiliations
    University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
    Search for articles by this author
  • Chelsea Anderson
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
    Search for articles by this author
  • Wendy R. Brewster
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
    Search for articles by this author
  • Andrew F. Olshan
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
    Search for articles by this author
  • Hazel B. Nichols
    Affiliations
    Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
    Search for articles by this author
Published:September 07, 2022DOI:https://doi.org/10.1016/j.jgo.2022.08.020

      Abstract

      Introduction

      Among women with early-stage endometrial cancer (EC), age, stage, grade, and histology are used to determine fitness for adjuvant radiation therapy (RT) administration. We examined non-cancer factors associated with adjuvant RT receipt in older women with early-stage EC.

      Materials & methods

      Using data from the Surveillance Epidemiology and End Results cancer registry program linked with Medicare claims, we identified 25,654 women (aged ≥66 years) diagnosed with first primary stage I-II EC during 2004–2017 who underwent a hysterectomy. Diagnosis and procedure codes were used to identify adjuvant RT claims filed for the seven-month period post-hysterectomy. Multivariable log-binomial regression was used to estimate adjuvant RT prevalence associated with patient characteristics and health system factors after adjustment for age, frailty, and endometrial factors.

      Results

      Adjuvant RT was less commonly administered to Asian American and Pacific Islander patients than non-Hispanic White patients (Prevalence ratio [PR], 0.84; 95% confidence interval [CI], 0.73 to 0.97). Compared to women treated in the Northeast region, women treated other regions of the US were less likely to undergo adjuvant RT (PR, 0.75; 95% CI, 0.71 to 0.79). Residing in rural or high neighborhood-poverty counties was associated with lower adjuvant RT administration. Higher comorbidity score was not associated with reduced prevalence of adjuvant RT receipt; however, women with high probability of predicted probability of frailty were less likely to undergo adjuvant RT (PR, 0.67; 95% CI, 0.55 to 0.81) compared to women with low probability of frailty. Women who received lymph node assessment were more likely to undergo adjuvant RT compared to women who did not (PR, 1.43; 95% CI, 1.34 to 1.51). Women treated by a gynecologic oncologist were more likely to undergo adjuvant RT compared to women treated by a non-gynecologic oncologist (PR 1.09; 95% CI, 1.04 to 1.14). Adjuvant RT was more commonly administered to women treated in larger academic hospitals.

      Discussion

      Findings suggest that various non-cancer factors affect the delivery of adjuvant RT to older women with early-stage EC in real-world oncology practice. Advancing our understanding of factors associated with adjuvant RT administration may help expand equitable access to RT.

      Keywords

      Abbreviations:

      EC (Endometrial Cancer), RT (Radiation Therapy), SEER (The Surveillance Epidemiology and End Results cancer registry program), EBRT (External Beam Radiation Therapy), VBT (Vaginal Brachytherapy)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Henley S.J.
        • Ward E.M.
        • Scott S.
        • Ma J.
        • Anderson R.N.
        • Firth A.U.
        • et al.
        Annual report to the nation on the status of cancer, part I: national cancer statistics.
        Cancer. 2020; 126: 2225-2249
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30
      1. Cancer Stat Facts: Uterine Cancer. Surveillance, Epidemiology, and End Results Program (SEER). National Cancer Institute, 2022 (Available from)
        • Gupta D.
        Clinical behavior and treatment of endometrial Cancer.
        Adv Exp Med Biol. 2017; 943: 47-74
        • Keys H.M.
        • Roberts J.A.
        • Brunetto V.L.
        • Zaino R.J.
        • Spirtos N.M.
        • Bloss J.D.
        • et al.
        A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a gynecologic oncology group study.
        Gynecol Oncol. 2004; 92: 744-751
        • Creutzberg C.L.
        • van Putten W.L.
        • Koper P.C.
        • Lybeert M.L.
        • Jobsen J.J.
        • Wárlám-Rodenhuis C.C.
        • et al.
        Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Post operative radiation therapy in endometrial carcinoma.
        Lancet. 2000; 355: 1404-1411
        • Suidan R.S.
        • He W.
        • Sun C.C.
        • Zhao H.
        • Smith G.L.
        • Klopp A.H.
        • et al.
        National trends, outcomes, and costs of radiation therapy in the management of low- and high-intermediate risk endometrial cancer.
        Gynecol Oncol. 2019; 152: 439-444
        • Wong A.T.
        • Rineer J.
        • Schwartz D.
        • Weiner J.
        • Safdieh J.
        • Choi K.
        • et al.
        Patterns of adjuvant radiation usage and survival outcomes for stage I endometrial carcinoma in a large hospital-based cohort.
        Gynecol Oncol. 2017; 144: 113-118
        • Lee J.K.
        • Ghanem A.I.
        • Modh A.
        • Burmeister C.
        • Mahmoud O.
        • Maxwell G.L.
        • et al.
        The impact of adjuvant vaginal brachytherapy in women with stage II uterine endometrioid carcinoma: results of a National Cancer Database analysis.
        Brachytherapy. 2018; 17: 319-325
        • Torgeson A.
        • Boothe D.
        • Poppe M.M.
        • Suneja G.
        • Gaffney D.K.
        Disparities in care for elderly women with endometrial cancer adversely effects survival.
        Gynecol Oncol. 2017; 147: 320-328
        • Sharma C.
        • Deutsch I.
        • Lewin S.N.
        • Burke W.M.
        • Qiao Y.
        • Sun X.
        • et al.
        Lymphadenectomy influences the utilization of adjuvant radiation treatment for endometrial cancer.
        Am J Obstet Gynecol. 2011; 205 (562.e1-9)
        • Madison T.
        • Schottenfeld D.
        • James S.A.
        • Schwartz A.G.
        • Gruber S.B.
        Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival.
        Am J Public Health. 2004; 94: 2104-2111
        • Martra F.
        • Kunos C.
        • Gibbons H.
        • Zola P.
        • Galletto L.
        • DeBernardo R.
        • et al.
        Adjuvant treatment and survival in obese women with endometrial cancer: an international collaborative study.
        Am J Obstet Gynecol. 2008; 198 (89.e1-8)
        • Truong P.T.
        • Kader H.A.
        • Lacy B.
        • Lesperance M.
        • MacNeil M.V.
        • Berthelet E.
        • et al.
        The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer.
        Am J Clin Oncol. 2005; 28: 157-164
        • NCCN
        NCCN clinical practice guidelines in oncology - older adult.
        National Comprehensive Cancer Network. 2021; 1: 55-56
        • Warren J.L.
        • Klabunde C.N.
        • Schrag D.
        • Bach P.B.
        • Riley G.F.
        Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.
        Med Care. 2002; 40 (IV-3-18)
      2. National Cancer Institute: Overview of the SEER Program.
        (Available from)
        • Gornick M.E.
        • Warren J.L.
        • Eggers P.W.
        • Lubitz J.D.
        • De Lew N.
        • Davis M.H.
        • et al.
        Thirty years of Medicare: impact on the covered population.
        Health Care Financ Rev. 1996; 18: 179-237
        • Potosky A.L.
        • Riley G.F.
        • Lubitz J.D.
        • Mentnech R.M.
        • Kessler L.G.
        Potential for cancer related health services research using a linked Medicare-tumor registry database.
        Med Care. 1993; 31: 732-748
        • Setiawan V.W.
        • Yang H.P.
        • Pike M.C.
        • McCann S.E.
        • Yu H.
        • Xiang Y.B.
        • et al.
        Type I and II endometrial cancers: have they different risk factors?.
        J Clin Oncol. 2013; 31: 2607-2618
        • Surveillance E, and End Results Program
        National Cancer Institute. Rural-Urban Continuum Codes.
        (Available from)
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Faurot K.R.
        • Jonsson Funk M.
        • Pate V.
        • Brookhart M.A.
        • Patrick A.
        • Hanson L.C.
        • et al.
        Using claims data to predict dependency in activities of daily living as a proxy for frailty.
        Pharmacoepidemiol Drug Saf. 2015; 24: 59-66
        • Cuthbertson C.C.
        • et al.
        Validating a medicare claims-based model to classify phenotypic frailty in older adults.
        in: Innovation in Aging. 2017
        • Lund J.L.
        • Sanoff H.K.
        • Peacock Hinton S.
        • Muss H.B.
        • Pate V.
        • Stürmer T.
        Potential medication-related problems in older breast, colon, and lung cancer patients in the United States.
        Cancer Epidemiol Biomarkers Prev. 2018; 27: 41-49
        • Mahdi H.
        • Schlick C.J.
        • Kowk L.L.
        • Moslemi-Kebria M.
        • Michener C.
        Endometrial cancer in Asian and American Indian/Alaskan native women: tumor characteristics, treatment and outcome compared to non-Hispanic white women.
        Gynecol Oncol. 2014; 132: 443-449
        • Fried L.P.
        • Ferrucci L.
        • Darer J.
        • Williamson J.D.
        • Anderson G.
        Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
        • Chang S.
        • Goldstein N.E.
        • Dharmarajan K.V.
        Managing an older adult with Cancer: considerations for radiation oncologists.
        Biomed Res Int. 2017; 2017: 1695101
        • Luo L.Y.
        • Aviki E.M.
        • Lee A.
        • Kollmeier M.A.
        • Abu-Rustum N.R.
        • Tsai C.J.
        • et al.
        Socioeconomic inequality and omission of adjuvant radiation therapy in high-risk, early-stage endometrial cancer.
        Gynecol Oncol. 2021; 161: 463-469
        • Enewold L.
        • Parsons H.
        • Zhao L.
        • Bott D.
        • Rivera D.R.
        • Barrett M.J.
        • et al.
        Updated overview of the SEER-Medicare data: enhanced content and applications.
        J Natl Cancer Inst Monogr. 2020; 2020: 3-13