Hadley W Reid1, Gloria Broadwater2, Mary Katherine Montes de Oca3, Bharathi Selvan4, Oluwadamilola Fayanju5, Laura J Havrilesky6, Brittany A Davidson7. 1. Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA. Electronic address: hadley.reid@duke.edu. 2. Duke Cancer Institute Biostatistics, Duke University Medical Center, DUMC Box 2717, Durham, NC, USA. Electronic address: gloria.broadwater@duke.edu. 3. Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA. Electronic address: mary.montes.de.oca@duke.edu. 4. Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA. Electronic address: Bharathi.selvan@duke.edu. 5. Department of Surgery, Duke University School of Medicine, DUMC 3513, Durham, NC 27710, USA. Electronic address: oluwadamilola.fayanju@pennmedicine.upenn.edu. 6. Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA. Electronic address: laura.havrilesky@duke.edu. 7. Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA. Electronic address: brittany.davidson@duke.edu.
Abstract
OBJECTIVES: Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS: We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS: 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS: An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.
OBJECTIVES: Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS: We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS: 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS: An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.
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