Early surgery increases risk of death for some uterine cancer patients, Penn study finds

December 16, 2016

PHILADELPHIA - Delaying surgery after a diagnosis of uterine cancer can increase a women's risk of death, but operating too soon can be just as detrimental for some, Penn Medicine physicians report in a new study published in the American Journal of Obstetrics and Gynecology. In the study, women who had surgery (usually to remove the uterus) within the first two weeks after diagnosis had a significantly increased risk of death within five years, compared to those who had surgery three or four weeks after their initial diagnosis.

The investigators examined more than 200,000 cases in the United States. Nearly two-thirds of the cases studied (140,078) were considered low-risk cancers. Of those, patients who had surgery in the first or second week after diagnosis had a 14 percent increased risk of death within five years compared to patients who had surgery in week three or four. For women with high-risk cancers (68,360), that number jumped to 20 percent. The risk, the authors suggest, is likely rooted in the delivery of care, rather than the cancer itself. In both risk groups, patients undergoing early surgery were more likely to die within 30 days of their operation. These patients were also more likely to be black, have advanced stage disease, have no insurance or be on Medicaid, and receive care at low-volume hospitals.

"We suspect that physicians diagnosing endometrial cancer may believe, not unreasonably, that the best thing they can do for those patients is to operate as soon as possible, because if they wait too long the cancer could progress, resulting in a worse outcome," said senior author David I. Shalowitz, MD, a fellow in Gynecologic Oncology at the Perelman School of Medicine at the University of Pennsylvania. "But, the results of our study suggest that pre-surgical care and referring patients to a gynecologic oncologist may be more important."

This year, over 60,000 women in the United States will be diagnosed with endometrial cancer, or cancer of the lining of the uterus. That number is expected to grow as obesity rates rise, since being obese increases a woman's risk of endometrial cancer, according to the National Cancer Institute. Endometrial cancer generally occurs in post-menopausal women over 50. In many cases, cancer-related symptoms such as abnormal menstruation send women to the doctor, allowing care providers to diagnose the condition early. Overall, the five-year survival rate is 82 percent.

Researchers also observed higher mortality rates in women with low-risk cancers whose surgery took place eight weeks or more after diagnosis. Long wait times have been associated with poorer survival outcomes in breast, rectal and bladder cancers; however, past studies of endometrial cancer have produced mixed findings. Factors such as poor access to care, insurance status, and pre-existing conditions like heart disease, could delay surgeries.

Five-year survival rates worsened as time-to-surgery increased, the study found: from 84.5 percent at eight weeks to 82.1 percent at week 11, to 78.6 percent at week 15, for example. There was no increased risk of death for women with high-risk cancers who had surgery after the third week, suggesting that for these women, the type and extent of disease at diagnosis contributes more to survival outcomes than progression of disease during the wait for surgery, the authors said.

The team recommends that the target interval between diagnosis and treatment be less than eight weeks, especially for women with low-risk cancers. They also call on gynecologic oncologists and policy makers to make use of these findings to help develop national practice standards for uterine cancer care delivery.

"Knowledge is power," Shalowitz said. "The primary goal is to make sure that there is a mechanism in place so that women who have a cancer diagnosis can see a specialist in the appropriate time period, that they are able to physically get to a high-volume treatment center, and that the process of referral and medical optimization for surgery can be done expediently."
-end-
Penn co-authors include Andrew J. Epstein, Lindsey Buckingham, Emily M. Ko, and Robert L. Giuntoli, II.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania(founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.

University of Pennsylvania School of Medicine

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.