Disparities in the surgical staging of high-grade endometrial cancer in the United States.


BACKGROUND: The National Comprehensive Cancer Network (NCCN) and the Society of Gynecologic Oncology (SGO) recommend lymph node sampling (LNS) as a key component in the surgical staging of high-grade endometrial cancer. Our goal was to examine surgical staging patterns for high-grade endometrial cancer in the United States. METHODS: The National Cancer Data Base (NCDB) was searched for patients who underwent surgery for serous, clear cell, or grade 3 endometrioid endometrial cancer. Outcomes were receipt of LNS and overall survival (OS). Multivariate logistic regression was used to examine receipt of LNS in Stage I-III disease based on race (White vs. Black), income, surgical volume, and distance traveled to care. Multivariate Cox proportional hazards regression modeling was used to assess OS based on stage, race, income, LNS, surgical volume, and distance traveled. RESULTS: Forty-two thousand nine hundred seventy-three patients were identified: 76% White, 53% insured by Medicare/Medicaid, 24% traveled >30 miles, and 33% stage III disease. LNS was similar among White and Black women (81% vs 82%). LNS was more common among >30 miles traveled (84% vs 81%, p < 0.001), higher surgical volume (83% vs 80%, p < 0.001), and academic centers (84% vs 80%, p < 0.001). In multivariate analysis, higher income, higher surgical volume, Charlson-Deyo score, and distance traveled were predictors of LNS. Stage III disease (HR 3.39, 95% CI 3.28-3.50), age (10-year increase; HR 1.63, 95% CI 1.61-1.66), lack of LNS (HR 1.64, 95% CI 1.56-1.69), and low income (HR 1.20, 95% CI 1.14-1.27) were predictors of lower survival. CONCLUSIONS: Surgical care for high-grade endometrial cancer in the United States is not uniform. Improved access to high quality care at high volume centers is needed to improve rates of recommended LNS.





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Publication Info

Foote, Jonathan R, Stephanie Gaillard, Gloria Broadwater, Julie A Sosa, Brittany Davidson, Mohamed A Adam, Angeles Alvarez Secord, Monica B Jones, et al. (2017). Disparities in the surgical staging of high-grade endometrial cancer in the United States. Gynecol Oncol Res Pract, 4. p. 1. 10.1186/s40661-016-0036-3 Retrieved from https://hdl.handle.net/10161/14627.

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Brittany A Davidson

Associate Professor of Obstetrics and Gynecology

My research passion lies at the intersection of gynecologic cancers and palliative care, helping patients with GYN cancers and their families navigate the journey of their cancer diagnoses to maximize their quality of life and mitigate aggressive and futile care near the end of life. I am also passionate about how the healthcare team communicates with patients and their families. Cancer care should be patient-centered based on an individual's own values--this requires comprehensive goals of care conversations early and often throughout the cancer trajectory. This has led me to become involved in VitalTalk Communication Skills training, which I have taught both locally at Duke and across the country to clinicians in various clinical settings. 

Clinically, caring for patients with gestational trophoblastic neoplasms and cancers in adolescents and young adults is a rewarding aspect of my job. Helping patients and their families navigate cancer diagnoses and the potential impact this has on growing families is rewarding. I enjoy working in a multi-disciplinary approach with our reproductive endocrinology, psychology, and cancer support teams to maximize longevity, quality of life and family building opportunities. 

As the program director for the OB/GYN department, medical education and simulation is also near and dear to my heart. I find great joy in mentoring trainees at all stages and in all venues--clinically, research, and professionally.


Junzo Paul Chino

Associate Professor of Radiation Oncology

Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology Resident Education, Stereotactic Radiation Therapy, and Brachytherapy

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