Researchers say early surgery increases risk of death for some uterine cancer

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The timing of surgical intervention in uterine cancer after diagnosis has significant effect on the outcome of the surgery. It is important to ensure that patients are healthy for surgery and have access to specialists and this should take priority over timing.
Although, delaying surgery after a diagnosis of uterine cancer increases a women’s risk of death, however, early operation can be just as detrimental for some according to findings in the Penn Medicine physicians report recently published in the American Journal of Obstetrics and Gynecology.

The researchers reviewed more than 200,000 cases in the United States. Nearly two-thirds of the cases studied (140,078) were considered low-risk cancers. It was found that patients who had surgery in the first or second week after diagnosis had a 14 percent higher 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 increased to 20 percent. The risk, the authors say, 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.

According to David I. Shalowitz, “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”. He adds that “but, the results of our study suggest that pre-surgical care and referring patients to a gynecologic oncologist may be more important.”

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The team also observed increased mortality rates in women with low-risk cancers whose surgery were done eight weeks or more after diagnosis. Prolong wait times have been linked to poorer survival outcomes in breast, rectal and bladder cancers; however, previous 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 deteriorated as time-to-surgery increased, the study revealed thus: from 84.5 percent at eight weeks to 82.1 percent at week 11, to 78.6 percent at week 15, for example. It was also reported that 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 according to the authors.

The team suggests that the target interval between diagnosis and treatment should be less than eight weeks, particularly for women with low-risk cancers. They also advice gynecologic oncologists and policy makers to adopt these findings to help formulate national practice standards for uterine cancer care delivery.

Shalowitz said “Knowledge is power,” and “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.”

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David I. Shalowitz (2016): Survival Implications of Time to Surgical Treatment of Endometrial Cancers, American Journal of Obstetrics and Gynecology, doi: 10.1016/j.ajog.2016.11.1050

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