Original Research
Gynecology
Receipt of adjuvant endometrial cancer treatment according to race: an NRG Oncology/Gynecologic Oncology Group 210 Study

https://doi.org/10.1016/j.ajog.2018.08.002Get rights and content

Background

Black women with endometrial cancer are more likely to die of their disease compared with white women with endometrial cancer. These survival disparities persist even when disproportionately worse tumor characteristics among black women are accounted. Receipt of less complete adjuvant treatment among black patients with endometrial cancer could contribute to this disparity.

Objective

We assessed the hypothesis that black women with endometrial cancer are less likely than their white counterparts to receive adjuvant treatment within subgroups defined by tumor characteristics in the NRG Oncology/Gynecology Oncology Group 210 Study.

Study Design

Our analysis included 615 black and 4283 white women with endometrial cancer who underwent hysterectomy. Women completed a questionnaire that assessed race and endometrial cancer risk factors. Tumor characteristics were available from pathology reports and central review. We categorized women as low-, intermediate-, or high-risk based on the European Society for Medical Oncology definition. Adjuvant treatment was documented during postoperative visits and was categorized as no adjuvant treatment (54.3%), radiotherapy only (16.5%), chemotherapy only (15.2%), and radiotherapy plus chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios and 95% confidence intervals for multivariable-adjusted associations between race and adjuvant treatment in the overall study population and stratified by tumor subtype, stage, or European Society for Medical Oncology risk category.

Results

Overall, black women were more likely to have received chemotherapy only (odds ratio, 1.40; 95% confidence interval, 1.04–1.86) or radiotherapy plus chemotherapy (odds ratio, 2.01; 95% confidence interval, 1.54–2.62) compared with white women in multivariable-adjusted models. No racial difference in the receipt of radiotherapy only was observed. In tumor subtype-stratified models, black women had higher odds of receiving radiotherapy plus chemotherapy than white women when diagnosed with low-grade endometrioid (odds ratio, 2.04; 95% confidence interval, 1.06–3.93) or serous tumors (odds ratio, 1.81; 95% confidence interval, 1.07–3.08). Race was not associated with adjuvant treatment among women who had been diagnosed with other tumor subtypes. In stage-stratified models, we observed no racial differences in the receipt of adjuvant treatment. In models that were stratified by European Society for Medical Oncology risk group, black women with high-risk cancer were more likely to receive radiotherapy plus chemotherapy compared with white women (odds ratio, 1.41; 95% confidence interval, 1.03–1.94).

Conclusion

Contrary to our hypothesis, we observed higher odds of specific adjuvant treatment regimens among black women as compared with white women within specific subgroups of endometrial cancer characteristics.

Section snippets

Materials and Methods

The NRG Oncology/GOG 210 Study was conducted from September 22, 2003, to December 1, 2011, at 62 US institutions. Eligible patients included women with presurgical diagnoses of EC or carcinosarcoma who were eligible for surgery and had not undergone previous retroperitoneal surgery or pelvic/abdominal radiation. Before surgery (hysterectomy, bilateral salpingo-oophorectomy, and lymph node sampling at the discretion of the treating provider), consenting patients completed a self-administered

Results

Of the 4898 study participants, 12% (n=615) self-reported black race. Table 1 shows distributions of epidemiologic characteristics according to race. Compared with white women with EC, black women with EC were more likely to have less than high school education, have lower annual incomes, be nonusers of menopausal hormones, be obese, have more live births, and have a history of diabetes mellitus. Distributions of tumor and treatment characteristics among black and white women with EC are shown

Comment

On the whole, studies that evaluate survival after a cancer diagnosis demonstrate lower survival rates among black women compared with white women.29 Morris et al30 describe several mechanisms that likely contribute to this observation: aggressive clinical characteristics, lower socioeconomic status, higher prevalence of comorbid conditions, poor patient-provider interactions, and inferior treatment. In this large cohort of women with EC, we examined the receipt of specific adjuvant treatments

Acknowledgments

The authors acknowledge the significant contributions of the late Dr D. Scott McMeekin who worked extensively on the GOG-210 study and Drs Wei Deng and Shamshad Ali for their contributions to the GOG-210 study.

The following institutions participated in this study: Roswell Park Cancer Institute, University of Alabama at Birmingham, Duke University Medical Center, Abington Memorial Hospital, Walter Reed Army Medical Center, Wayne State University, University of Minnesota Medical School,

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  • Cited by (0)

    Supported by National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (CA 27469), the Gynecologic Oncology Group Statistical and Data Center (CA 37517) and the NRG Oncology Grant number: 1 U10 CA180822 and U10 CA180868. In addition, this research was supported in part by funds provided by the intramural research program of the National Cancer Institute, National Institutes of Health.

    The authors report no conflict of interest.

    Cite this article as: Felix AS, Cohn DE, Brasky TM, et al. Receipt of adjuvant endometrial cancer treatment according to race: an NRG Oncology/Gynecologic Oncology Group 210 Study. Am J Obstet Gynecol 2018;219:459.e1-11.

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