Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer Journal Article

   

Authors:	Manning-Geist, B. L.; Rios-Doria, E.; Aviki, E. M.; Zhou, Q.; Iasonos, A.; Abu-Rustum, N. R.; Brown, C. L.; Mueller, J. J.
Article Title:	Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer
Abstract:	Objective: In 2018, evidence-based surgical guidelines were introduced to identify appropriate patients with low-grade endometrioid endometrial cancer for ovarian conservation. We sought to identify trends and demographic shifts associated with guideline implementation. Methods: We identified women treated for endometrioid endometrial cancer at our institution from January 2010 to June 2021. Eligibility criteria included age ≤50 years, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome or Lynch syndrome, and no hormone receptor-positive malignancy. Trends in ovarian conservation were examined with the Cochran-Armitage trend test or in a logistic regression model. Associations between ovarian conservation and clinicodemographic factors before and after guideline implementation were compared using Wilcoxon rank-sum and Fisher's exact tests. Results: Of 420 women ≤50 years of age undergoing surgery for endometrioid endometrial cancer, 355 (85%) met the criteria for ovarian conservation - 267 (75%) before and 88 (25%) after guideline implementation. Median patient age was 45 years (range 25-50); 62% were non-Hispanic White, 10% Hispanic White, 8% non-Hispanic Black, 0% Hispanic Black, and 20% Asian. Patients were significantly more likely to choose ovarian conservation after (48%) compared with before guideline implementation (21%) (p<0.001). Pre-guidelines, non-Hispanic White women were less likely to elect for ovarian conservation (12%) compared with non-Hispanic Black, Asian, or Hispanic White women (28%) (p=0.002). Similarly, older women were less likely to elect for ovarian conservation compared with younger women (p<0.001). There were no differences by obesity (p=0.68), marital status (p=0.86), or insurance (p=0.89). Post-guidelines, there were no differences in ovarian conservation between non-Hispanic White women (36%) and non-Hispanic Black, Asian, or Hispanic White women (50%) (p=0.56). Older women were still less likely to elect for ovarian conservationcompared with younger women (p<0.001). Conclusions: After guideline implementation, ovarian conservation increased and uptake disparities across demographic groups decreased. © 2022 IGCS and ESGO.
Keywords:	surgery; uterine cancer
Journal Title:	International Journal of Gynecological Cancer
Volume:	32
Issue:	9
ISSN:	1048-891X
Publisher:	Lippincott Williams & Wilkins
Date Published:	2022-09-01
Start Page:	1141
End Page:	1146
Language:	English
DOI:	10.1136/ijgc-2022-003661
PUBMED:	35831030
PROVIDER:	scopus
PMCID:	PMC10428184
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85134468765&doi=10.1136%2fijgc-2022-003661&partnerID=40&md5=8dad66f5975ecf12dfdb6ce551ac854a
Notes:	Article -- Export Date: 3 October 2022 -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/198309