Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study
Purpose Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideli...
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| Veröffentlicht in: | Archives of gynecology and obstetrics 2022, Vol.305 (1), p.203-213 |
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| creator | Scharl, Sophia Sprötge, Tim Gerken, Michael Scharl, Anton Ignatov, Atanas Inwald, Elisabeth C. Ortmann, Olaf Kölbl, Oliver Klinkhammer‑Schalke, Monika Papathemelis, Thomas |
| description | Purpose
Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age.
Methods
The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology.
Results
Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (
p
= 0.015) or higher age (
p
|
| doi_str_mv | 10.1007/s00404-021-06140-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2548606282</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2621816351</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-9f16c8f0b8d06ade295a955891beb423edb5a20de1a5f2ec4d7667fc170752d13</originalsourceid><addsrcrecordid>eNp9kcGO1SAUhonRONfRF3BhSNy4qR4o0NadmThqMokbXRMKpx0mLVSgi7v2xYfrHTVx4QoI__-dk3yEvGTwlgF07zKAANEAZw0oJqCRj8iBiZY30DH2mBxgON1BdRfkWc53AIz3vXpKLlrBeTt04kB-XhtbYsrUh2nZMVgfZloSmrJiKNSh9dnHQE1wdN69w8UHpDaGKabVl2Pt0Vs_3zZzMg4pBhdXLMmbhVoTLCa6meIrKr-nhm5x25f6jqEZTUZHc9nd8Tl5Mpkl44uH85J8v_747epzc_P105erDzeNbTtZmmFiyvYTjL0DVYfxQZpByn5gI46Ct-hGaTg4ZEZOHK1wnVLdZFkHneSOtZfkzZm7pfhjx1z06rPFZTEB4541l6JXoHjPa_T1P9G7uKdQt9NccdYz1coTkJ9TNsWcE056S3416agZ6JMifVakqyL9S5GWtfTqAb2PK7o_ld9OaqA9B3L9CjOmv7P_g70HoAOeUg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2621816351</pqid></control><display><type>article</type><title>Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Scharl, Sophia ; Sprötge, Tim ; Gerken, Michael ; Scharl, Anton ; Ignatov, Atanas ; Inwald, Elisabeth C. ; Ortmann, Olaf ; Kölbl, Oliver ; Klinkhammer‑Schalke, Monika ; Papathemelis, Thomas</creator><creatorcontrib>Scharl, Sophia ; Sprötge, Tim ; Gerken, Michael ; Scharl, Anton ; Ignatov, Atanas ; Inwald, Elisabeth C. ; Ortmann, Olaf ; Kölbl, Oliver ; Klinkhammer‑Schalke, Monika ; Papathemelis, Thomas</creatorcontrib><description><![CDATA[Purpose
Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age.
Methods
The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology.
Results
Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (
p
= 0.015) or higher age (
p
< 0.01). Guideline adherence was not affected by comorbidities (
p
= 0.563), but was significantly reduced with higher age (
p
< 0.01). In a multivariable model, higher age (
p
< 0.01), obesity (
p
= 0.011), higher FIGO Stage (
p
< 0.01) and histologic subtype (
p
< 0.01) significantly decreased OS. Surgery (
p
< 0.001), chemotherapy (
p
< 0.01) and systematic LNE (
p
= 0.011) were associated with higher OS.
Conclusion
Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.]]></description><identifier>ISSN: 0932-0067</identifier><identifier>EISSN: 1432-0711</identifier><identifier>DOI: 10.1007/s00404-021-06140-5</identifier><identifier>PMID: 34223974</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adaptation ; Cancer surgery ; Cancer therapies ; Carcinosarcoma - pathology ; Chemotherapy ; Comorbidity ; Conformity ; Endocrinology ; Endometrial cancer ; Endometrial Neoplasms - pathology ; Female ; Gynecologic Oncology ; Gynecology ; Human Genetics ; Humans ; Hysterectomy ; Medicine ; Medicine & Public Health ; Neoplasm Staging ; Obstetrics ; Obstetrics/Perinatology/Midwifery ; Oncology ; Patients ; Population-based studies ; Radiation therapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Tumors</subject><ispartof>Archives of gynecology and obstetrics, 2022, Vol.305 (1), p.203-213</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-9f16c8f0b8d06ade295a955891beb423edb5a20de1a5f2ec4d7667fc170752d13</citedby><cites>FETCH-LOGICAL-c375t-9f16c8f0b8d06ade295a955891beb423edb5a20de1a5f2ec4d7667fc170752d13</cites><orcidid>0000-0001-6849-6880</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00404-021-06140-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00404-021-06140-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34223974$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scharl, Sophia</creatorcontrib><creatorcontrib>Sprötge, Tim</creatorcontrib><creatorcontrib>Gerken, Michael</creatorcontrib><creatorcontrib>Scharl, Anton</creatorcontrib><creatorcontrib>Ignatov, Atanas</creatorcontrib><creatorcontrib>Inwald, Elisabeth C.</creatorcontrib><creatorcontrib>Ortmann, Olaf</creatorcontrib><creatorcontrib>Kölbl, Oliver</creatorcontrib><creatorcontrib>Klinkhammer‑Schalke, Monika</creatorcontrib><creatorcontrib>Papathemelis, Thomas</creatorcontrib><title>Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study</title><title>Archives of gynecology and obstetrics</title><addtitle>Arch Gynecol Obstet</addtitle><addtitle>Arch Gynecol Obstet</addtitle><description><![CDATA[Purpose
Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age.
Methods
The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology.
Results
Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (
p
= 0.015) or higher age (
p
< 0.01). Guideline adherence was not affected by comorbidities (
p
= 0.563), but was significantly reduced with higher age (
p
< 0.01). In a multivariable model, higher age (
p
< 0.01), obesity (
p
= 0.011), higher FIGO Stage (
p
< 0.01) and histologic subtype (
p
< 0.01) significantly decreased OS. Surgery (
p
< 0.001), chemotherapy (
p
< 0.01) and systematic LNE (
p
= 0.011) were associated with higher OS.
Conclusion
Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.]]></description><subject>Adaptation</subject><subject>Cancer surgery</subject><subject>Cancer therapies</subject><subject>Carcinosarcoma - pathology</subject><subject>Chemotherapy</subject><subject>Comorbidity</subject><subject>Conformity</subject><subject>Endocrinology</subject><subject>Endometrial cancer</subject><subject>Endometrial Neoplasms - pathology</subject><subject>Female</subject><subject>Gynecologic Oncology</subject><subject>Gynecology</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Staging</subject><subject>Obstetrics</subject><subject>Obstetrics/Perinatology/Midwifery</subject><subject>Oncology</subject><subject>Patients</subject><subject>Population-based studies</subject><subject>Radiation therapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Retrospective Studies</subject><subject>Tumors</subject><issn>0932-0067</issn><issn>1432-0711</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kcGO1SAUhonRONfRF3BhSNy4qR4o0NadmThqMokbXRMKpx0mLVSgi7v2xYfrHTVx4QoI__-dk3yEvGTwlgF07zKAANEAZw0oJqCRj8iBiZY30DH2mBxgON1BdRfkWc53AIz3vXpKLlrBeTt04kB-XhtbYsrUh2nZMVgfZloSmrJiKNSh9dnHQE1wdN69w8UHpDaGKabVl2Pt0Vs_3zZzMg4pBhdXLMmbhVoTLCa6meIrKr-nhm5x25f6jqEZTUZHc9nd8Tl5Mpkl44uH85J8v_747epzc_P105erDzeNbTtZmmFiyvYTjL0DVYfxQZpByn5gI46Ct-hGaTg4ZEZOHK1wnVLdZFkHneSOtZfkzZm7pfhjx1z06rPFZTEB4541l6JXoHjPa_T1P9G7uKdQt9NccdYz1coTkJ9TNsWcE056S3416agZ6JMifVakqyL9S5GWtfTqAb2PK7o_ld9OaqA9B3L9CjOmv7P_g70HoAOeUg</recordid><startdate>2022</startdate><enddate>2022</enddate><creator>Scharl, Sophia</creator><creator>Sprötge, Tim</creator><creator>Gerken, Michael</creator><creator>Scharl, Anton</creator><creator>Ignatov, Atanas</creator><creator>Inwald, Elisabeth C.</creator><creator>Ortmann, Olaf</creator><creator>Kölbl, Oliver</creator><creator>Klinkhammer‑Schalke, Monika</creator><creator>Papathemelis, Thomas</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6849-6880</orcidid></search><sort><creationdate>2022</creationdate><title>Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study</title><author>Scharl, Sophia ; Sprötge, Tim ; Gerken, Michael ; Scharl, Anton ; Ignatov, Atanas ; Inwald, Elisabeth C. ; Ortmann, Olaf ; Kölbl, Oliver ; Klinkhammer‑Schalke, Monika ; Papathemelis, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-9f16c8f0b8d06ade295a955891beb423edb5a20de1a5f2ec4d7667fc170752d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adaptation</topic><topic>Cancer surgery</topic><topic>Cancer therapies</topic><topic>Carcinosarcoma - pathology</topic><topic>Chemotherapy</topic><topic>Comorbidity</topic><topic>Conformity</topic><topic>Endocrinology</topic><topic>Endometrial cancer</topic><topic>Endometrial Neoplasms - pathology</topic><topic>Female</topic><topic>Gynecologic Oncology</topic><topic>Gynecology</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Staging</topic><topic>Obstetrics</topic><topic>Obstetrics/Perinatology/Midwifery</topic><topic>Oncology</topic><topic>Patients</topic><topic>Population-based studies</topic><topic>Radiation therapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Retrospective Studies</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scharl, Sophia</creatorcontrib><creatorcontrib>Sprötge, Tim</creatorcontrib><creatorcontrib>Gerken, Michael</creatorcontrib><creatorcontrib>Scharl, Anton</creatorcontrib><creatorcontrib>Ignatov, Atanas</creatorcontrib><creatorcontrib>Inwald, Elisabeth C.</creatorcontrib><creatorcontrib>Ortmann, Olaf</creatorcontrib><creatorcontrib>Kölbl, Oliver</creatorcontrib><creatorcontrib>Klinkhammer‑Schalke, Monika</creatorcontrib><creatorcontrib>Papathemelis, Thomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scharl, Sophia</au><au>Sprötge, Tim</au><au>Gerken, Michael</au><au>Scharl, Anton</au><au>Ignatov, Atanas</au><au>Inwald, Elisabeth C.</au><au>Ortmann, Olaf</au><au>Kölbl, Oliver</au><au>Klinkhammer‑Schalke, Monika</au><au>Papathemelis, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study</atitle><jtitle>Archives of gynecology and obstetrics</jtitle><stitle>Arch Gynecol Obstet</stitle><addtitle>Arch Gynecol Obstet</addtitle><date>2022</date><risdate>2022</risdate><volume>305</volume><issue>1</issue><spage>203</spage><epage>213</epage><pages>203-213</pages><issn>0932-0067</issn><eissn>1432-0711</eissn><abstract><![CDATA[Purpose
Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age.
Methods
The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology.
Results
Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (
p
= 0.015) or higher age (
p
< 0.01). Guideline adherence was not affected by comorbidities (
p
= 0.563), but was significantly reduced with higher age (
p
< 0.01). In a multivariable model, higher age (
p
< 0.01), obesity (
p
= 0.011), higher FIGO Stage (
p
< 0.01) and histologic subtype (
p
< 0.01) significantly decreased OS. Surgery (
p
< 0.001), chemotherapy (
p
< 0.01) and systematic LNE (
p
= 0.011) were associated with higher OS.
Conclusion
Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.]]></abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34223974</pmid><doi>10.1007/s00404-021-06140-5</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-6849-6880</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0932-0067 |
| ispartof | Archives of gynecology and obstetrics, 2022, Vol.305 (1), p.203-213 |
| issn | 0932-0067 1432-0711 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2548606282 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adaptation Cancer surgery Cancer therapies Carcinosarcoma - pathology Chemotherapy Comorbidity Conformity Endocrinology Endometrial cancer Endometrial Neoplasms - pathology Female Gynecologic Oncology Gynecology Human Genetics Humans Hysterectomy Medicine Medicine & Public Health Neoplasm Staging Obstetrics Obstetrics/Perinatology/Midwifery Oncology Patients Population-based studies Radiation therapy Radiotherapy, Adjuvant Retrospective Studies Tumors |
| title | Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study |
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