BACKGROUND Fragmentation of cancer care (FC) occurs when patients receive treatment across several different hospitals. Regionalization of surgery for patients with high grade endometrial cancer means that patients must travel longer distances to receive care; these patients often require adjuvant treatment after surgery. OBJECTIVES To determine whether the fragmentation of surgery and adjuvant treatment impacts survival in patients with high grade non-endometrioid endometrial cancer. METHODS This population-based retrospective cohort study included patients diagnosed between 2003-2017 with high-grade non-endometrioid endometrial cancer who received adjuvant treatment post-operatively. Non-fragmented care (NFC) was defined as receiving surgery and adjuvant treatment at the same institution. The primary outcome was overall survival (OS). RESULTS We identified 1,795 patients, of whom 583 (32.5%) had FC. Patients with NFC were more likely to have had surgery by a Gynecologic Oncologist (92.4 vs 58.8%, p<0.001), surgical staging (66.6 vs 44.8%, p<0.001), and less travel for surgery (mean 30.8 km vs 93.7 km, p<0.001). They were less likely to receive chemotherapy (26.3 vs 30%, p<0.001) and chemoradiation (38.4 vs 41.3%, p<0.001). Median survival was 9 years. There was no significant difference in OS between patients who received FC and NFC. 92.4 and 93.5% of the patients in the FC and NFC groups were treated at a specialized gynecologic oncology center for at least part of their treatment (surgery, adjuvant treatment or both). CONCLUSIONS We have previously shown that regionalization of surgery in high-grade endometrial cancer is associated with improved survival. Fragmentation of surgery and adjuvant treatment in this population does not have an adverse effect on survival. After receiving surgical treatment with a Gynecologic Oncologist, these patients may receive adjuvant treatment closer to home to decrease financial and travel burden.

中文翻译：

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手术碎片化和辅助治疗对高级别非子宫内膜样子宫内膜癌的影响：一项基于人群的队列研究。


背景 当患者在几家不同的医院接受治疗时，就会发生癌症护理 （FC） 的碎片化。高级别子宫内膜癌患者的手术区域化意味着患者必须长途跋涉才能接受治疗;这些患者在手术后通常需要辅助治疗。目的 确定手术和辅助治疗的碎片化是否会影响高级别非子宫内膜样子宫内膜癌患者的生存。方法 这项基于人群的回顾性队列研究包括 2003-2017 年诊断为高级别非子宫内膜样子宫内膜癌且术后接受辅助治疗的患者。非碎片化护理 （NFC） 被定义为在同一机构接受手术和辅助治疗。主要结局是总生存期 （OS）。结果 我们确定了 1,795 例患者，其中 583 例 （32.5%） 患有 FC。NFC 患者更有可能接受妇科肿瘤科医生的手术 （92.4 vs 58.8%，p<0.001）、手术分期 （66.6 vs 44.8%，p<0.001） 和较少的手术旅行 （平均 30.8 公里 vs 93.7 公里，p<0.001）。他们接受化疗 （26.3 vs 30%，p<0.001） 和放化疗 （38.4 vs 41.3%，p<0.001） 的可能性较小。中位生存期为 9 年。接受 FC 和 NFC 的患者之间的 OS 无显著差异。FC 和 NFC 组中 92.4% 和 93.5% 的患者在专门的妇科肿瘤中心接受了至少部分治疗（手术、辅助治疗或两者兼而有之）的治疗。结论 我们之前已经表明，高级别子宫内膜癌手术的区域化与生存率的提高有关。 在该人群中，手术和辅助治疗的碎片化对生存率没有不利影响。在接受妇科肿瘤科医生的手术治疗后，这些患者可能会在离家更近的地方接受辅助治疗，以减少经济和旅行负担。