1. Receipt of Adjuvant Endometrial Cancer Treatment According to Race NRG Oncology/Gynecologic Oncology Group (GOG) 210 Study
Ashley Felix, PhD, MPH
Assistant Professor of Epidemiology
Ohio State University College of Public Health
NRG Scientific Session
July 19, 2019

2. Disclosures
No disclosures.

3. Cancer Health Disparities
Cancer health disparities are adverse differences between certain population groups in cancer measures, such as: incidence, prevalence, morbidity (cancer-related health complication), mortality, survivorship and quality of life after cancer treatment, burden of cancer or related health conditions, screening rates, and stage at diagnosis
Examine differences between Black and White women
Residual direct effect: Measures the racial differences NOT mediated by measurable disadvantage (e.g. education differences)

4. Blacks are more likely to die from EC than whites
Black women are 93% more likely to die from endometrial cancer compared to white women
Annual Report to the Nation on the Status of Cancer,

5. Black women have more aggressive EC
Stage Distribution for Uterine Cancer by Race, United States, 2008 to 2014
Age-adjusted Uterine Cancer Incidence Rates by Histology and Race, United States, 2000 to 2011
Annual Report to the Nation on the Status of Cancer,
Cote ML et al. CEBP 2014

6. Is more aggressive disease the whole story?
Black women are more likely to have more advanced stage disease and aggressive histology – factors that contribute to their worse survival
However, within these subgroups, racial disparities still exist

7. Is more aggressive disease the whole story?
Low-grade endometrioid
All histological types
High-grade endometrioid
Serous
Cote ML et al. CEBP 2014

8. Other factors that might contribute to racial disparities in EC survival
Lower socioeconomic status
Higher prevalence of comorbid conditions
Poor patient-provider interactions
Inferior treatment
Surgery is less common among Black women with EC compared to White women
Adjuvant treatment differences?

9. Based on poorer survival we hypothesized receipt of adjuvant treatment would be lower among African-American compared to White endometrial cancer patients

10. NRG Oncology/Gynecologic Oncology Group (GOG) 210 Trial
Molecular and pathological staging trial
>6,000 endometrial cancer patients enrolled
Risk factor questionnaire administered prior to standard treatment
Central pathology review

11. Methods
Classified treatment as no adjuvant, radiation only, chemotherapy only, radiation plus chemotherapy
No information on radiation type/dose, chemotherapy agent/dose
Odds of receiving adjuvant treatment according to race stratified by histology or stage
Polytomous logistic regression: ORs and 95% CI

12. Results N=4,898 (Black, n=615, White, n=4,283)
Model adjusted for age at diagnosis, tumor subtype, stage, annual income, educational attainment
Results
N=4,898 (Black, n=615, White, n=4,283)

13. Model adjusted for age at diagnosis, tumor subtype, stage, annual income, educational attainment

14. Results No differences by stage
Could not examine race and treatment associations in strata cross-classified by histology and stage

15. Discussion Findings were in contrast to our hypotheses
Lack of information on other factors that guide treatment (e.g. patient preferences, overall health status)
Increased clinician awareness of poorer survival among black as compared with white endometrial cancer patients
Additional hypotheses of interest
Quality of patient-provider interactions
Regional variations in treatment patterns

16. Acknowledgements Grant/Sponsor Acknowledgements Author’s Affiliations
Ohio State University, Pennsylvania State University, Memorial Sloan Kettering Cancer Center, Washington University School of Medicine, Medical University of South Carolina, University of Oklahoma, Brown University, Roswell Park Cancer Institute, University of Colorado Cancer Center, University of Minnesota, Case Western Reserve University, University of North Carolina, State University of New York at Stony Brook, University of Maryland, University of Kentucky, National Cancer Institute
Grant/Sponsor Acknowledgements
This study was 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 CA 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