Introduction/Background Endometrial cancer (EC) is the most frequent gynecological malignancy and studies have shown that demographic attributes could influence quality of care. We aim to review their impact on compliance to standard treatment guidelines in EC with already published quality metrics.
Methodology Using the Surveillance Epidemiology and End Results (SEER) database 1988–2013 we identified 151,752 patients treated for EC in the United States. The quality indicators (QI) were extracted from a Belgian study on quality of care in EC. Ten QI were selected because of their relevance and applicability to the SEER. These QI either evaluated the surgical management, the adjuvant treatment decision, or the outcome in EC. We examined the association between socio-demographic characteristics (race, age, insurance status, income, and marital status) and quality of care using a logistic regression model.
Results Concerning the six surgical QI, one was accurately met (>80% population received the recommended treatment), three were moderately met (50–79%) and two were poorly met (<50%). For example, 91% of the patients with a type 1/2, FIGO stage I EC underwent a total hysterectomy with bilateral salpingo-oophorectomy. Concerning the three QIs reporting outcome, one was well met (99.3% alive one month after surgery) and two were moderately met (71% alive at 5 years and 52% of the patients deceased, died from EC). The adjuvant QI was not well met (30% FIGO I/II EC who did not undergo surgery, received radiotherapy). All socio-demographic characteristics studied were associated with low adherence to the QI. Age over 75 years old, black ethnicity, lower income group, without partner and un-insured, had a negative impact on the compliance to standard treatment.
Conclusion The 10 Belgian QI used to assess quality of care in the United States showed an overall correct compliance to standard treatment. Demographic discrepancies persist in the management of EC, impacting evidence-based care.
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