Disparities in initial systemic staging imaging workup for endometrial cancer.

Abstract

e17614 Background: Endometrial cancer (EC) is the sixth most common cancer in females, with rising incidence. CT chest (CT-C), CT abdomen and pelvis (CT-AP), PET/CT, or MRI abdomen and pelvis (MRI-AP) evaluate for distant metastasis. It is known that disadvantaged populations experience poorer EC outcomes. However, unlike in lung, rectal and prostate cancer, imaging disparities in female reproductive cancers have not been studied. We aim to study socioeconomic disparities in radiological workup for EC. Methods: Retrospective review of consecutive EC patients from a single institution from 2018-2022 was performed. Exclusion criteria included cancer other than EC, inadequate documentation, workup outside the US, workup refused, or workup not indicated. Independent variables included age, race, ethnicity, BMI, insurance, date of diagnosis (DOD), histological grade, image setting, and socioeconomic status. Dependent variables included completeness and timeliness of radiological workup. Workup was categorized as complete or incomplete based on widely available national guidelines. For high grade EC, complete was defined as CT-C and CT-AP, PET/CT, or MRI-AP and CT-C; low grade did not require CT-C. Images performed in the inpatient or emergency setting were excluded. Timeliness was defined as days between DOD and imaging completion. Statistical analysis used the Wilcoxon, Kruskal Wallis, and Chi Square tests. Results: Of 689 patients, 615 were included. 57.3% completed systemic workup. Among those with incomplete workup, 77.4% received no initial staging CT, PET/CT or MRI. Completion rates between race, ethnicity, BMI, and state SES groups were similar. Though non-significant, Medicare had higher completion (62.2%) than private (54.3%), Medicaid (54.4%) and uninsured (55.9%). Median time to workup completion was longer for Hispanic ethnicity (48.5 vs 34 days, p=0.004), high BMI (39 vs 34, p=0.03), and DOD after 2021 (42 vs 33, p=0.001). Medicaid and uninsured received less timely workup than Medicare or private patients (49 and 49.5 vs 32.5 and 34, p=0.002). Conclusions: Adherence to systemic staging guidelines was mediocre across EC patients regardless of race, ethnicity or SES. Interestingly, private payer completion rate was similar to medicaid and lower than medicare, although not reaching statistical significance. Finally, social determinants of health—particularly ethnicity, insurance, and BMI—are associated with reduced access to timely EC imaging workup, impacting treatment.