Poster Presentation 26th Lorne Cancer Conference 2014

Patterns of care for women with invasive endometrial cancer – results from the population-based Australian National Endometrial Cancer study (#159)

Alison M Hadley 1 2 , Suzanne C Dixon 1 , Michael Quinn 3 , Penny Blomfield 4 , Andreas Obermair 5 , Alison Brand 6 , Martin K Oehler 7 , Margaret Davy 7 , Yee Leung 8 , Penny M Webb 1
  1. Gynaecological Cancers Group, Population Health Department , QIMR Berghofer Medical Research Institute, Brisbane , Queensland
  2. Department of Medical Oncology , Royal Brisbane and Women's Hospital, Herston, Queensland
  3. Department of Obstetrics and Gynaecology , Royal Women’s Hospital and University of Melbourne, Melbourne, Victoria
  4. Department of Gynaecological Oncology, Royal Hobart Hospital, Hobart, Tasmania
  5. Queensland Centre for Gynaecological Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland
  6. Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW
  7. Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia
  8. School of Women’s and Infants’ Health, WA Gynaecologic Cancer Service, University of Western Australia, Perth, Western Australia

Objective

Emerging personalised therapies will impact upon future management of endometrial cancer; current treatment guidelines are imprecise given an absence of survival benefit or clear evidence of best practice for some facets of treatment.  This study aimed to address information regarding primary treatment received by women with endometrial cancer in Australia.

Methods

Data was analysed from 1408 participants from the Australian National Endometrial Cancer Study (ANECS). Cases included Australian residents aged 18–79 years, with histologically confirmed endometrial cancer diagnosed from May 2005 - December 2007.  Demographics, tumour characteristics and treatment details were collected. Patients were classified into low-, intermediate- and high-risk groups based on surgical stage, grade and histology.  Multivariable logistic regression was used to identify factors associated with therapy received. 

Results

Most women underwent total hysterectomy.  Laparoscopic surgery was performed in 34% and was significantly associated with low grade on curettings (p<0.0001) and urban residence (p=0.0006).  Women with high-grade cancers and non-obese women were significantly more likely to undergo lymphadenectomy (p<0.0001).  The likelihood of receiving laparoscopic surgery or lymphadenectomy varied significantly by state (p<0.0001).  Intermediate and high-risk patients were significantly more likely (OR>80) to receive adjuvant radiotherapy than their low-risk counterparts.   Brachytherapy alone was utilised more often for intermediate- than high-risk participants.  Adjuvant chemotherapy was received by 11%, almost all of whom were high-risk.  State of residence predicted radiotherapy and chemotherapy use; in particular Queensland was significantly less likely to administer radiotherapy compared with most states (p<0.0001), but with a higher use of chemotherapy (non-significant).  

Conclusions

Higher tumour risk was associated with more aggressive surgical strategies and adjuvant chemo- and radiotherapy.  For urban and non-obese women, laparoscopic surgery was more frequent.  State variations were seen in laparoscopy, lymphadenectomy rates and radiotherapy use.  Understanding drivers underpinning treatment selection may provide impetus for further research, therapies and health care planning.