Highlights
- •Timely surgery is linked to outcome in endometrial cancer patients.
- •Disparities in the receipt of timely surgery are noted among marginalized patients in Ontario's public healthcare system.
- •Other surgical quality indicators are not associated with social determinants of health in Ontario.
- •Reducing surgical wait times among marginalized cancer patients is an important deliverable in public healthcare.
Abstract
Objective
Timely surgery has been shown to impact outcome in endometrial cancer patients. Social
determinants of health (SDH) are associated with adverse cancer outcomes. We sought
to evaluate the association of SDH with surgical treatment indicators in endometrial
cancer patients in a public healthcare system.
Methods
Endometrial cancer patients in Ontario, Canada, diagnosed between 2009 and 2017 were
identified, and clinical, social and demographic variables were extracted from administrative
databases. Validated community marginalization scores that include material deprivation,
residential instability and ethnic concentration were used for stratification. Surgical
treatment features were compared across marginalization quintiles using chi-square,
Fischer exact or Wilcoxon rank sum tests as appropriate. Predictors of timely surgical
treatment were evaluated with logistic regression.
Results
20228 patients were identified of whom 14,423 had primary hysterectomy for a preoperative
diagnosis of endometrial cancer. Fewer patients in marginalized communities received
surgery (89% vs. 93%, p < 0.001). Surgical delay was longer among marginalized patients and 78% had surgery
within 12 weeks compared to 84% of those least marginalized (p < 0.0001). Other quality indicators of surgical treatment were not negatively associated
with marginalization. On multivariable analysis adjusted for patient and disease factors,
marginalization was independently associated with increased odds of delayed surgery
(OR = 0.94/quintile, CI 0.91–0.97, p < 0.001).
Conclusions
Social marginalization is associated with decreased likelihood of having surgery and
with delayed surgery among endometrial cancer patients in Ontario. This may be mediated
by delayed presentation and real or perceived barriers to access. Reducing surgical
wait times among marginalized cancer patients is an important deliverable in public
healthcare.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 12, 2020
Accepted:
August 24,
2020
Received:
June 23,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
