Abstract C159: Treatment determinants and outcomes among endometrial cancer patients: A systematic review
Abstract
The burden of endometrial cancer (EC), the most frequently diagnosed gynecologic cancer in the US, continues to rise, with EC mortality disproportionately affecting marginalized communities. This systematic review synthesizes evidence on treatment-related outcomes and multi-level determinants of care among US patients with endometrial cancer. We conducted a systematic search across PubMed, Scopus, and CINAHL for articles published before May 2026. Eligible studies were quantitative analyses that examined treatment-related outcomes among patients diagnosed with gynecologic cancers in the US. Treatment-related outcomes fell into at least one of the following categories: 1) treatment receipt, adherence, or completion; 2) timeliness of treatment; 3) referral or treatment delays; and 4) treatment quality metrics. Study population characteristics and information on determinants of treatment and treatment-related outcomes were extracted. We used an adapted version of the Mixed Methods Appraisal Tool to assess the quality of each included study. 5026 studies were identified, and 99 were included after abstract and full text review (27 endometrial, 26 cervical, 46 ovarian). Among the 27 included EC articles, 29 treatment outcomes were identified; 18 (62%) outcomes were surgical, and 6 (21%) outcomes were related to radiation therapy, while other outcomes included receipt of chemotherapy, gynecologic oncologist involvement, and treatment delay. Patient-level determinants included age, race/ethnicity, comorbidities, frailty level, marital status, insurance status, distance to care, rurality, geographic region, and year of surgery or diagnosis. Black race and Hispanic ethnicity were associated with worse treatment-related outcomes, particularly experiencing treatment delays. Longer distance to care was a barrier to EC treatment. Physician volume and gynecologic oncologist involvement were frequent provider-level determinants, while clinic-level determinants included hospital region, rurality, EC volume, general volume, capacity, type, and disproportionate share payments. Higher hospital volume was associated with high-quality surgical care and increased receipt of adjuvant radiotherapy. Finally, area-level income measures were contextual-level determinants of EC treatment; higher area-level income was consistently positively associated with receipt of chemotherapy and surgery, particularly minimally invasive surgery. Improving treatment received by EC patients requires attention not just to patient-level determinants, but also to higher-level, structural barriers, especially for marginalized patients. Clearly defining and targeting the characteristics of EC patients and the communities they reside in may help inform strategies to deliver more equitable cancer care. Brianna D. Taffe, Cecilia A. Cortez, Charlotte Ellis, Benjamin B. Albright, Carrie Baldwin-SoRelle, Blen M. Biru, Victoria Petermann, Jennifer Leeman, Stephanie B. Wheeler, Lisa P. Spees. Treatment determinants and outcomes among endometrial cancer patients: A systematic review [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C159.