December 20, 2016

Early Surgery Increases Risk of Death for Some Patients With Uterine Cancer

PHILADELPHIA -- December 20, 2016 -- Delaying surgery after a diagnosis of uterine cancer can increase a women’s risk of death, but operating too soon can be just as detrimental for some, according to a study published in the American Journal of Obstetrics and Gynecology.

In the study, women who had surgery within the first 2 weeks after diagnosis had a significantly increased risk of death within 5 years compared with those who had surgery 3 or 4 weeks after their initial diagnosis.

The investigators examined more than 200,000 cases in the United States. Of the cases studied, 140,078 were considered low-risk cancers. Of those, patients who had surgery in the first or second week after diagnosis had a 14% increased risk of death within 5 years compared with patients who had surgery in week 3 or 4. For women with high-risk cancers (n = 68,360), that number jumped to 20%.

The risk, the authors suggest, is likely rooted in the delivery of care, rather than the cancer itself. In both risk groups, patients undergoing early surgery were more likely to die within 30 days of their operation. These patients were also more likely to be black, have advanced stage disease, have no insurance or be on Medicaid, and receive care at low-volume hospitals.

“We suspect that physicians diagnosing endometrial cancer may believe, not unreasonably, that the best thing they can do for those patients is to operate as soon as possible, because if they wait too long the cancer could progress, resulting in a worse outcome,” said senior author David I. Shalowitz, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. “But, the results of our study suggest that pre-surgical care and referring patients to a gynaecologic oncologist may be more important.”

Researchers also observed higher mortality rates in women with low-risk cancers whose surgery took place 8 weeks or more after diagnosis. Long wait times have been associated with poorer survival outcomes in breast, rectal, and bladder cancers; however, past studies of endometrial cancer have produced mixed findings. Factors such as poor access to care, insurance status, and pre-existing conditions like heart disease, could delay surgeries.

The study found that 5-year survival rates worsened as time-to-surgery increased (84.5% at 8 weeks, 82.1% at week 11, 78.6% at week 15). There was no increased risk of death for women with high-risk cancers who had surgery after the third week, suggesting that for these women, the type and extent of disease at diagnosis contributes more to survival outcomes than progression of disease during the wait for surgery, the authors said.

The team recommends that the target interval between diagnosis and treatment be less than 8 weeks, especially for women with low-risk cancers. They also call on gynaecologic oncologists and policy makers to make use of these findings to help develop national practice standards for uterine cancer care delivery.

“Knowledge is power,” said Dr. Shalowitz. “The primary goal is to make sure that there is a mechanism in place so that women who have a cancer diagnosis can see a specialist in the appropriate time period, that they are able to physically get to a high-volume treatment centre, and that the process of referral and medical optimisation for surgery can be done expediently.”

SOURCE: University of Pennsylvania Perelman School of Medicine

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