Exploring access barriers for patients with uterine malignancies: Results from a single-center analysis.

Abstract

e13507 Background: Uterine cancer typically presents with early symptomatic bleeding; delayed presentation can result in diagnosis at an advanced stage with poor prognosis and limited treatment options. Geographic barriers to care or psychological distress may contribute to delayed diagnoses. This study aimed to: (1) explore the impact of two factors—geodesic distance from our institution and patient-reported distress at intake—on endometrial cancer stage at diagnosis, and (2) investigate associations of these factors with tumor p53 status, a marker of aggressive disease. Methods: This retrospective study was conducted using a clinical genomics database for patients with gynecologic cancers treated at a single academic institution, selecting patients with primary uterine malignancies. Data on stage at diagnosis, tumor p53 status, patient home zip code, and patient-reported distress, gathered at intake using the NCCN Distress Thermometer, were extracted. Stage at diagnosis was grouped into early (I or II), or late (III or IV). Distress scores were grouped into low (0-2), moderate (3-6), and high (7-10). Geodesic distance (i.e., as-the-crow-flies) to our institution was calculated and grouped into 0-10, 10-25, and 25+ miles. Chi-square tests of independence were performed for association analysis. Results: Ninety-seven patients were identified, with 72 having tumor p53 status available. For patients with distress scores available (n = 59), tumor p53 status was known for 50. There was no association between distress and stage at diagnosis, (Χ 2 (2, N = 59) = 0.54, p = .76), nor between distress and tumor p53 status (X 2 (2, N = 50) = 0.24, p = .87). Among geodesic distance cohorts, we did not observe a difference in stage at diagnosis (Χ 2 (2, N = 97) = 0.21, p = .90), nor in tumor p53 status (Χ 2 (2, N = 72) = 3.84, p = .15). Conclusions: No evidence was found supporting an association between geodesic distance and late diagnosis of uterine malignancies or tumor p53 status. This may be unique to our patient population, served by multiple academic institutions in the dense states of RI, MA, and CT. Alternatively, an association may only be appreciable at greater distances than we studied. We did not find evidence of an association between psychological distress and late diagnosis. As distress is a multivariate problem, individual analysis of the component factors of the NCCN Distress Score may yield useful insights. Early Stagen (% of row) Late Stagen (% of row) Total p53 Wild Typen (% of row) p53 Mutantn (% of row) Total NCCN Distress Thermometer 28 (47%) 31 (53%) 59 34 (68%) 16 (32%) 50 Low (0-2) 5 (38%) 8 (62%) 13 8 (67%) 4 (33%) 12 Mod (3-6) 11 (50%) 11 (50%) 22 13 (72%) 5 (28%) 18 High (7-10) 12 (50%) 12 (50%) 24 13 (65%) 7 (35%) 20 Geodesic Dist. to Institution 52 (54%) 45 (46%) 97 44 (61%) 28 (39%) 72 0 to 10 mi 26 (55%) 21 (45%) 47 27 (71%) 11 (29%) 38 10 to 25 mi 14 (50%) 14 (50%) 28 7 (44%) 9 (56%) 16 25 mi+ 12 (57%) 9 (43%) 21 10 (56%) 8 (44%) 18