PO45

Abstract

Purpose Endometrial cancer (EC) is the most common gynecologic malignancy and the fourth most common cancer in women [1]. Treatment is composed of a total hysterectomy, possibly followed by adjuvant chemotherapy or radiation therapy (RT) based on risk factors and staging [2]. Consistent follow up after treatment is integral to assessing for both toxicities and recurrence. Encouraging adjuvant vaginal dilator use has been shown to prevent vaginal stenosis, a common side effect of both surgery and RT [2]. However, about 9% of the female population in the USA face significant geographical barriers to receiving gynecologic cancer treatment [3]. Furthermore, previous studies showed being over 50 miles from a high-volume hospital was associated with increased risk of non-adherence care and increased mortality [4]. Increased time from endometrial biopsy to surgery is one documented factor that increased risk of poor outcomes [5]. This retrospective study evaluates if geographical location is associated with access to endometrial cancer care and post-radiation vaginal stenosis. Materials and Methods Patients enrolled in the study underwent surgery +/- RT for Stage I-IIIC endometrial cancer. Vaginal dilator use was recommended to all patients receiving RT. Vaginal length at follow up visits was measured with a vaginal sound. Data from patient charts was used to determine patient demographics, location, and follow up care. Results Forty-two patients had sufficient data for analysis. Average distance from the treatment hospital was 40.9 miles, 54% of patients lived in an urban county. Average number of days from an endometrial biopsy to surgical treatment was 43 days. Living >80 miles from the hospital was associated with an 80% increase in the days between an endometrial biopsy and surgery, compared to those living within 20 miles (p<0.01). Average months of follow up after surgery was 31. There was no impact of an increased distance from the hospital affecting months of follow-up care, vaginal stenosis, or dilator adherence. Conclusions This study provides evidence that living extreme distances from a high-volume cancer center is associated with delayed access to care. Furthermore, there's no direct impact of geography on post-RT vaginal dilation or adherence to care. Our findings suggest reduced discrimination in EC care despite geographical barriers. Further studies to evaluate impact of geography on mortality rates are needed. References: 1. BRAUN MM, OVERBEEK-WAGER EA, GRUMBO RJ. Diagnosis and Management of Endometrial Cancer. Am Fam Physician. 2016;93(6):468-474. Accessed January 30, 2023. https://www.aafp.org/pubs/afp/issues/2016/0315/p468.html2. Quinn, BA, et al. Change in Vaginal Length and Sexual Function in Women Who Undergo Surgery ± Radiation Therapy for Endometrial Cancer . Brachytherapy, 2023. In press.3. Shalowitz DI, Vinograd AM, Giuntoli RL. Geographic access to gynecologic cancer care in the United States. Gynecol Oncol. 2015;138(1):115-120. doi:10.1016/J.YGYNO.2015.04.0254. Bristow RE, Powell MA, Al-Hammadi N, et al. Disparities in Ovarian Cancer Care Quality and Survival According to Race and Socioeconomic Status. JNCI Journal of the National Cancer Institute. 2013;105(11):823. doi:10.1093/JNCI/DJT0655. Shalowitz DI, Epstein AJ, Buckingham L, Ko EM, Giuntoli RL. Survival implications of time to surgical treatment of endometrial cancers. Am J Obstet Gynecol. 2017;216(3):268.e1-268.e18. doi:10.1016/j.ajog.2016.11.1050 Endometrial cancer (EC) is the most common gynecologic malignancy and the fourth most common cancer in women [1]. Treatment is composed of a total hysterectomy, possibly followed by adjuvant chemotherapy or radiation therapy (RT) based on risk factors and staging [2]. Consistent follow up after treatment is integral to assessing for both toxicities and recurrence. Encouraging adjuvant vaginal dilator use has been shown to prevent vaginal stenosis, a common side effect of both surgery and RT [2]. However, about 9% of the female population in the USA face significant geographical barriers to receiving gynecologic cancer treatment [3]. Furthermore, previous studies showed being over 50 miles from a high-volume hospital was associated with increased risk of non-adherence care and increased mortality [4]. Increased time from endometrial biopsy to surgery is one documented factor that increased risk of poor outcomes [5]. This retrospective study evaluates if geographical location is associated with access to endometrial cancer care and post-radiation vaginal stenosis. Patients enrolled in the study underwent surgery +/- RT for Stage I-IIIC endometrial cancer. Vaginal dilator use was recommended to all patients receiving RT. Vaginal length at follow up visits was measured with a vaginal sound. Data from patient charts was used to determine patient demographics, location, and follow up care. Forty-two patients had sufficient data for analysis. Average distance from the treatment hospital was 40.9 miles, 54% of patients lived in an urban county. Average number of days from an endometrial biopsy to surgical treatment was 43 days. Living >80 miles from the hospital was associated with an 80% increase in the days between an endometrial biopsy and surgery, compared to those living within 20 miles (p<0.01). Average months of follow up after surgery was 31. There was no impact of an increased distance from the hospital affecting months of follow-up care, vaginal stenosis, or dilator adherence. This study provides evidence that living extreme distances from a high-volume cancer center is associated with delayed access to care. Furthermore, there's no direct impact of geography on post-RT vaginal dilation or adherence to care. Our findings suggest reduced discrimination in EC care despite geographical barriers. Further studies to evaluate impact of geography on mortality rates are needed. References: 1. BRAUN MM, OVERBEEK-WAGER EA, GRUMBO RJ. Diagnosis and Management of Endometrial Cancer. Am Fam Physician. 2016;93(6):468-474. Accessed January 30, 2023. https://www.aafp.org/pubs/afp/issues/2016/0315/p468.html2. Quinn, BA, et al. Change in Vaginal Length and Sexual Function in Women Who Undergo Surgery ± Radiation Therapy for Endometrial Cancer . Brachytherapy, 2023. In press.3. Shalowitz DI, Vinograd AM, Giuntoli RL. Geographic access to gynecologic cancer care in the United States. Gynecol Oncol. 2015;138(1):115-120. doi:10.1016/J.YGYNO.2015.04.0254. Bristow RE, Powell MA, Al-Hammadi N, et al. Disparities in Ovarian Cancer Care Quality and Survival According to Race and Socioeconomic Status. JNCI Journal of the National Cancer Institute. 2013;105(11):823. doi:10.1093/JNCI/DJT0655. Shalowitz DI, Epstein AJ, Buckingham L, Ko EM, Giuntoli RL. Survival implications of time to surgical treatment of endometrial cancers. Am J Obstet Gynecol. 2017;216(3):268.e1-268.e18. doi:10.1016/j.ajog.2016.11.1050