Healthcare utilization in women diagnosed with endometrial cancer: A survey-based study

Nerlyne Desravines; Dana Hazimeh; Michael R Desjardins; Stephanie L Wethington

doi:10.1016/j.ygyno.2024.03.015

Healthcare utilization in women diagnosed with endometrial cancer: A survey-based study

Gynecol Oncol. 2024 Mar 29:186:1-8. doi: 10.1016/j.ygyno.2024.03.015. Online ahead of print.

Authors

Nerlyne Desravines¹, Dana Hazimeh¹, Michael R Desjardins², Stephanie L Wethington³

Affiliations

¹ The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States of America.
² Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
³ The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States of America. Electronic address: swethington@jhmi.edu.

PMID: 38554624
DOI: 10.1016/j.ygyno.2024.03.015

Abstract

Objective: Despite similar incidence, non-Hispanic Black women are twice as likely to die of endometrial cancer as non-Hispanic White women. The social determinants of health may contribute to this disparity. We studied barriers to care and social needs of endometrial cancer patients.

Methods: In a cohort of patients with endometrial cancer from the All of Us study, participants self-reported demographics and completed validated surveys (access to medical care, transportation, caregiving, finances, medication, general care, specialty care, housing insecurity). Univariate and multivariate logistic regression models evaluated demographic and access factors associated with any need.

Results: Of 568 participants, 77.7% identified as non-Hispanic White, 7.5% Black, and 8.8% Hispanic. 59% were > 65 years and 95.8% insured. Contributors to delays in care were paying out of pocket (9.9%), provider anxiety (7.6%), transportation (6.3%), cost of copay (6.2%), and insufficient leave from work (5.6%). To mitigate healthcare costs, 16.2% of participants inquired about lower-cost medications, 11.1% reported delaying filling prescriptions, 7.6% taking fewer prescribed medications, and 6.5% skipped doses. Regarding multivariate analysis, participants earning <$25,000 had a 7.3 (95% CI 1.7-31.7) higher adjusted odds of transportation needs and 3.6 (95% CI 1.4-9.7) higher difficulty accessing specialists. No racial/ethnic disparities were identified.

Conclusions: Social needs and barriers to care are most pronounced among endometrial cancer survivors earning <$25,000. Unexpectedly, and possibly related to sample size or survey tool, race/ethnicity were not zassociated with barriers to care. Further studies on health-related social needs, optimal screening tools, and effective interventions are needed in order to achieve equity in cancer outcomes for endometrial cancer patients.

Keywords: Endometrial cancer; Health related social needs; Racial disparities; Social determinants of health.