Abstract
BACKGROUND: To assess factors that may affect patients' adherence to recommended surveillance after treatment for endometrial cancer. METHODS: We performed a retrospective study of all patients undergoing primary treatment for endometrial cancer from January 1, 2010, to December 30, 2017, at a tertiary referral center. Patients were included for analysis if there was sufficient information in the electronic medical records. Patient demographic information, cancer characteristics, and surveillance adherence data were collected. The median inflation-adjusted income was calculated from the patients' ZIP codes and U.S. Census data. The primary outcome assessed was adherence to surveillance, defined as two or more visits per 12 months in individuals at low risk and four or more visits per 12 months in individuals at high risk, consistent with recommended guidelines. RESULTS: During the study period, 870 patients were included for analysis. The mean age at diagnosis and body mass index (BMI) of the entire cohort were 63.4 years and 35.8, respectively. Overall, 761 patients (87.5%) were adherent to the recommended surveillance guidelines. Patients who were not adherent to recommended surveillance lived significantly farther from the cancer center (39.2 miles vs 20.7 miles, P=.026) and had a significantly lower median inflation-adjusted income ($74,015 vs $80,435, P=.027). CONCLUSION: Increased distance to a tertiary care center and lower median income were significantly associated with decreased adherence to recommended surveillance guidelines. This is consistent with current literature on increased distance traveled as a proxy for worse survival in gynecologic malignancies, as well as worse endometrial cancer outcomes in patients of lower socioeconomic status. This highlights an area of disparity that needs improvement and warrants further investigation.