6 Variation in practice in endometrial cancer (EC); can molecular classification direct care and reduce costs associated with management?. (13th November 2020)

• Record Type: Journal Article
• Authors: Thompson, E; Lum, A; Huvila, J; Scott, S; Lui, V; He, E; Salisbury, T; Keane, S; Keane, S; Samouelian, V; Irving, J; Salvador, S; Helpman, L; Wohlmuth, C; Kinloch, M; Offman, S; Vicus, D; Grondin, K; Gtlieb, W; Plante, M; Huntsman, D; Talhouk, A; Gilks, CB; Hanley, G; McAlpine, J
• Is Part Of: International journal of gynecological cancer. Volume 30(2020)Supplement 3
• Page Start: A5
• Page End: A5
• Publication Date: 2020-11-13
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2020-IGCS.6
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: We wished to assess the potential impact of directing EC management based on molecular classification, and the projected cost implications of molecular subtype-directed care. Methods: Surgical staging, treatment, surveillance, and hereditary cancer program(HCP) referrals were assessed for all ECs managed in a single calendar year (2016) across 24 Canadian centers. Variation of practice was recorded, as well as where a change in management would be projected and associated cost implications of that change based on molecular subtype assignment. Results: Data from 862 patients revealed wide variation in surgical staging, with lymph node dissection(LND) performed in 61% of ECs (range 25–100%), including 38% LND in Gr1ECs (0–100%). Adjuvant therapy (type, when/if given) and cancer surveillance (frequency, site e.g., community vs. cancer center) was inconsistent within and across centers for both early-and late-stage disease. Molecular classification identified 29% MMRd ECs (n=247) but only 8% of these women had been referred to HCP. 30 women who did consult HCP were MMRproficient. 38% of MMRd ECs had no LND and 43% did not receive radiation. 16% and 18% of p53abn ECs had no LND or omentectomy respectively, and only 58% received chemotherapy. De-escalation of treatment in early-stage POLEmut and NSMP ECs (n=63 treated, where molecular classification would direct observation or brachytherapy-only) would have reduced costs by $348, 896–407, 830CAD or $5538–6466CAD per patient. Conclusions: There is currently profound variation in practice for all aspects of EC management with implications to patients and health systems. Molecular classification can provide consistency in care and direct biologically-informed management.