Quality of oncologic care and outcomes of patients with endometrial cancer managed at minority-serving hospitals

Objectives: Evaluate the outcomes of patients with endometrial cancer managed at minority-serving hospitals. Methods: The National Cancer Database was accessed, and patients diagnosed between 2004 and 2016 with a uterine, ovarian or cervical tumor with known race were identified. Minority-serving hospitals (MSH) were defined as those with the highest percentage (>75th percentile) of Hispanic, Black and Asian patients while non-MSH were defined at those with the lowest ( Results: A total of 1,312 facilities reporting patients with gynecologic malignancies were identified. In MSH and non-MSH hospitals, an average of 46.89% and 2.63% of patients were minorities, respectively. A total of 111222 patients with endometrial cancer who met the inclusion criteria were identified; 62.7% and 38.3% were managed at an MSH and a non-MSH hospital, respectively. Compared to patients managed at non-MSH those managed at an MSH were more likely to have comorbidities (74.2% vs 72.6%, p 10 days) (OR: 1.41, 95% CI: 1.30, 1.55). For patients with apparent-early stage disease, after controlling for age, insurance, histology and comorbidities, those who had a hysterectomy at an MSH had similar odds of undergoing minimally-invasive surgery (OR: 0.97, 95% CI: 0.93, 1.01). Patients with non-endometrioid tumors (OR: 0.90, 95% CI: 0.78, 1.05) or apparent stage IB, grade 2/3 endometrioid tumors (OR: 1.06, 95% CI: 0.92, 1.22) had similar odds of undergoing lymphadenectomy. Patients with stage III-IV disease, who were managed at an MSH had lower odds of receiving chemotherapy (OR: 0.90, 95% CI: 0.84, 0.96) after controlling for insurance, age, comorbidities and histology. After controlling for patient age, insurance status, comorbidities, histology, receipt of chemotherapy and radiation therapy and disease stage, treatment at an MSH was associated with worse survival (HR: 1.12, 95% CI: 1.09, 1.15) compared to treatment at a non-MSH. Conclusions: Significant disparities exist in the management, perioperative outcomes and survival of patients with endometrial cancer managed at MSH.