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Gaps in adjuvant treatment in elderly endometrial cancer patients
Abstracts / Gynecologic Oncology 133 (2014) 2–207
81 - Featured Poster An American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) evaluation of surgical outcomes in the elderly: Endometrial cancer patients undergoing hysterectomy C.V. Brown1, B. Wang2, J.M. Scalici2, R.P. Rocconi2, M.A. Finan2. a Vanderbilt University, Nashville, TN, USA, bUniversity of South Alabama, Mobile, AL, USA. Objectives: Endometrial cancer is common in the elderly. In this study, we analyzed patients with endometrial cancer who had undergone hysterectomy to determine the effect of advanced age on postoperative outcomes. Methods: Using the ACS-NSQIP database 2005–2011, comparative analyses were performed to determine the effect of age on preoperative characteristics, operative variables, and postoperative outcomes for patients with endometrial cancer who underwent hysterectomy. Data were analyzed using SPSS 20.0. Student's t-test, chi-square test, and Fisher's exact test were used as appropriate with univariate analyses. A logistic regression analysis for risk-adjusted odds ratios (ORs) was performed. Results: Those patients N80 years had a shorter duration of anesthesia and total operative time. The total operative time was significantly longer in the younger age group (P b 0.0001). The elderly group also had a longer length of total surgical stay and higher incidence of pneumonia, unplanned reintubation, urinary tract infection, septic shock, wound infection, and systemic sepsis. Patients b80 years had a higher rate of deep vein thrombosis and venous thromboembolism. The elderly group had a significantly higher risk of postoperative death (odds ratio = 5.31; 95% CI 2.40, 11.75; P b 0.0001), and this was predicted by a low preoperative albumin, receiver operating characteristic with AUC of 0.867 (Fig. 1). Conclusions: The older group was significantly more ill and had a higher rate of comorbidities than the younger group, as expected. Elderly patients had a significantly higher risk of death (OR 5.3, P b 0.0001), and this was predicted by a low albumin, particularly if b3.0 g/dL. If the patient is healthy, active, and has few comorbidities, surgery can be carried out safely with a minimal increase in morbidity in the elderly population. Caution should be exercised in the elderly with endometrial cancer, especially if they have significant comorbidities and/or albumin b3.0 g/dL.
doi:10.1016/j.ygyno.2014.03.101
33
82 - Featured Poster Gaps in adjuvant treatment in elderly endometrial cancer patients L.H. Clark1, A.L. Jackson1, V.L. Bae-Jump1, P.A. Gehrig1, L. Van Le1, E.M. Ko2. 1University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2University of Pennsylvania, Philadelphia, PA, USA. Objectives: Previous studies of elderly endometrial cancer (EC) patients have focused on women who received treatment but have not examined the subset of elderly patients who did not receive treatment, particularly in the adjuvant setting. We sought to determine the gap between recommended and received adjuvant treatment in elderly EC patients. Methods: Following institutional review board approval, we performed a retrospective review of all EC cases from a single tertiary care institution from 2005 to 2010. Clinical, surgical, and pathologic data were abstracted from medical records. Descriptive statistics were performed using univariate and bivariate analysis. Chi-square tests were used for categorical comparisons. Results: Of 1,064 EC patients who were reviewed, 27% (280/1064) were N70 years old. Grade 3 tumors were more common in the elderly, occurring in 62% (40/65) of octogenarians compared to 39% (333/854) of those 50 to 79 years and 22% (27/125) of those b50 years (P b 0.001). Endometrioid adenocarcinoma was the most common in all age groups but declined from 86% (107/125) in those b50 years to 59% (38/65) of octogenarians (P b 0.001). In contrast, the incidence of carcinosarcoma increased from 0.8% (1/125) in those b50 years to 15.4% (10/65) in octogenarians (P b 0.001). Increasing age was associated with more advanced-stage disease, with 11% (13/125) of those b50 years having stage III/IV disease compared to 25% (16/65) of octogenarians (P = 0.002). Among patients b50 years old, only 27.3% (n = 30) were recommended to undergo adjuvant treatment compared to 76% (n = 47) of octogenarians (P b 0.001). In contrast to recommended treatment, actual receipt of adjuvant radiation peaked at only 43% among women between the ages of 75 and 79 years. Chemotherapy uptake revealed a similar trend, with even lower receipt of treatment ranging from 19% at age b50 years to 36% at age 75 (Fig. 1). Conclusions: National Comprehensive Cancer Network guidelines recommend more adjuvant treatment in elderly EC patients due to a more advanced disease stage and aggressive histopathology. However, only 50% of elderly women for whom treatment was recommended actually received it in this study. Further research may determine what criteria are appropriate for declaring underor overtreatment in elderly EC patients, the barriers preventing elderly women from receiving guideline directed care, and where a balance between quality of life and optimal adjuvant treatment may be found.
doi:10.1016/j.ygyno.2014.03.102
81 - Featured Poster An American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) evaluation of surgical outcomes in the elderly: Endometrial cancer patients undergoing hysterectomy C.V. Brown1, B. Wang2, J.M. Scalici2, R.P. Rocconi2, M.A. Finan2. a Vanderbilt University, Nashville, TN, USA, bUniversity of South Alabama, Mobile, AL, USA. Objectives: Endometrial cancer is common in the elderly. In this study, we analyzed patients with endometrial cancer who had undergone hysterectomy to determine the effect of advanced age on postoperative outcomes. Methods: Using the ACS-NSQIP database 2005–2011, comparative analyses were performed to determine the effect of age on preoperative characteristics, operative variables, and postoperative outcomes for patients with endometrial cancer who underwent hysterectomy. Data were analyzed using SPSS 20.0. Student's t-test, chi-square test, and Fisher's exact test were used as appropriate with univariate analyses. A logistic regression analysis for risk-adjusted odds ratios (ORs) was performed. Results: Those patients N80 years had a shorter duration of anesthesia and total operative time. The total operative time was significantly longer in the younger age group (P b 0.0001). The elderly group also had a longer length of total surgical stay and higher incidence of pneumonia, unplanned reintubation, urinary tract infection, septic shock, wound infection, and systemic sepsis. Patients b80 years had a higher rate of deep vein thrombosis and venous thromboembolism. The elderly group had a significantly higher risk of postoperative death (odds ratio = 5.31; 95% CI 2.40, 11.75; P b 0.0001), and this was predicted by a low preoperative albumin, receiver operating characteristic with AUC of 0.867 (Fig. 1). Conclusions: The older group was significantly more ill and had a higher rate of comorbidities than the younger group, as expected. Elderly patients had a significantly higher risk of death (OR 5.3, P b 0.0001), and this was predicted by a low albumin, particularly if b3.0 g/dL. If the patient is healthy, active, and has few comorbidities, surgery can be carried out safely with a minimal increase in morbidity in the elderly population. Caution should be exercised in the elderly with endometrial cancer, especially if they have significant comorbidities and/or albumin b3.0 g/dL.
doi:10.1016/j.ygyno.2014.03.101
33
82 - Featured Poster Gaps in adjuvant treatment in elderly endometrial cancer patients L.H. Clark1, A.L. Jackson1, V.L. Bae-Jump1, P.A. Gehrig1, L. Van Le1, E.M. Ko2. 1University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2University of Pennsylvania, Philadelphia, PA, USA. Objectives: Previous studies of elderly endometrial cancer (EC) patients have focused on women who received treatment but have not examined the subset of elderly patients who did not receive treatment, particularly in the adjuvant setting. We sought to determine the gap between recommended and received adjuvant treatment in elderly EC patients. Methods: Following institutional review board approval, we performed a retrospective review of all EC cases from a single tertiary care institution from 2005 to 2010. Clinical, surgical, and pathologic data were abstracted from medical records. Descriptive statistics were performed using univariate and bivariate analysis. Chi-square tests were used for categorical comparisons. Results: Of 1,064 EC patients who were reviewed, 27% (280/1064) were N70 years old. Grade 3 tumors were more common in the elderly, occurring in 62% (40/65) of octogenarians compared to 39% (333/854) of those 50 to 79 years and 22% (27/125) of those b50 years (P b 0.001). Endometrioid adenocarcinoma was the most common in all age groups but declined from 86% (107/125) in those b50 years to 59% (38/65) of octogenarians (P b 0.001). In contrast, the incidence of carcinosarcoma increased from 0.8% (1/125) in those b50 years to 15.4% (10/65) in octogenarians (P b 0.001). Increasing age was associated with more advanced-stage disease, with 11% (13/125) of those b50 years having stage III/IV disease compared to 25% (16/65) of octogenarians (P = 0.002). Among patients b50 years old, only 27.3% (n = 30) were recommended to undergo adjuvant treatment compared to 76% (n = 47) of octogenarians (P b 0.001). In contrast to recommended treatment, actual receipt of adjuvant radiation peaked at only 43% among women between the ages of 75 and 79 years. Chemotherapy uptake revealed a similar trend, with even lower receipt of treatment ranging from 19% at age b50 years to 36% at age 75 (Fig. 1). Conclusions: National Comprehensive Cancer Network guidelines recommend more adjuvant treatment in elderly EC patients due to a more advanced disease stage and aggressive histopathology. However, only 50% of elderly women for whom treatment was recommended actually received it in this study. Further research may determine what criteria are appropriate for declaring underor overtreatment in elderly EC patients, the barriers preventing elderly women from receiving guideline directed care, and where a balance between quality of life and optimal adjuvant treatment may be found.
doi:10.1016/j.ygyno.2014.03.102