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Endometrial Ca HCP Survey
Challenges to Optimal Care for Endometrial Cancer: HCP Survey Results

Released: July 25, 2023

Ritu Salani
Ritu Salani, MD, MBA
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Key Takeaways
  • A survey of healthcare professionals (HCPs) revealed that 2 of 5 HCPs report “never,” “rarely,” or “sometimes” discussing clinical trial enrollment with patients who have endometrial cancer. However, guidelines strongly recommend discussing trial enrollment with all patients.
  • When asked to identify factors contributing to health inequities for Black patients with endometrial cancer, fewer than one half of HCPs accurately identified the key reasons: lack of guideline-concordant care, lower participation in clinical trials, and a higher likelihood of presenting with advanced disease.
  • To learn more about caring for patients with advanced endometrial cancer, please visit the CCO website often as this educational program unfolds.

HCPs face many challenges when caring for patients with endometrial cancer, from the rapid evolution of treatment options to understanding the causes behind health inequities. In this commentary, Ritu Salani, MD, MBA, discusses findings from a recent survey among a global audience of 112 HCPs caring for patients with endometrial cancer.

Key Finding 1: Discussing Clinical Trial Enrollment With Patients
Our survey showed that 2 of 5 HCPs “never,” “rarely,” or “sometimes” discuss clinical trials with their patients who have advanced endometrial cancer. This result is concerning because NCCN guidelines consider clinical trials to be the best course of management for any patient with cancer. Clinical trials enable patients to receive the optimal standard of care, along with the possibility of treatments that may improve outcomes. Furthermore, data indicate that clinical trial participants live longer than nonparticipants.

Not discussing clinical trials may further exacerbate health inequities among vulnerable populations with endometrial cancer. Data show that Black women are just as likely to agree to participate in clinical trials as White women, but only 3.1% of participants identified as Black across 230 registrational trials leading to FDA oncology approvals from 2008-2018.

These data point to a need for improved understanding of the importance of discussing clinical trials, along with guidance on how to offer clinical trials to all patients with endometrial cancer.

Key Finding 2: Understanding Causes of Health Inequities for Black Patients
When asked to identify factors contributing to health inequities for Black patients, a minority of HCPs accurately identified the key reasons:

  • Only 28% agreed that Black patients are less likely to receive guideline-concordant care. Significantly lower rates of guideline-concordant care among Black vs White women have been reported in multiple studies, including a large 2020 analysis of the National Cancer Database and SEER cancer registry analyses published in 2018 and 2021.
  • Only 37% agreed that Black patients have lower participation in clinical trials. As discussed earlier, only 3.1% of participants identified as Black across 230 registrational oncology trials. This low participation rate is not because there are fewer Black patients with cancer. When standardized by the relative proportion of cancer incidence in the United States, these clinical trials should have enrolled approximately 4 times more Black participants.
  • Only 41% agreed that Black patients present more often with advanced disease. A large 2018 analysis of young women with endometrial cancer in the National Cancer Database found that Black women were significantly more likely to present with advanced disease. Similarly, a 2017 analysis reported that Black women had higher rates of advanced disease vs White women.

These data show an unmet need for education on the evidence behind health inequities for Black patients.

Key Finding 3: Identifying and Resolving Barriers to Care for Black or Masculine-Identifying Patients
The survey further showed that only 18% of HCPs reported high confidence in identifying and resolving patient barriers to guideline-concordant care in Black patients. Together with the previous key finding, these data emphasize a pressing need for guidance on how to recognize and address health inequities at the patient–provider level.

Survey data also highlighted challenges in providing care to transgender patients with endometrial cancer. Only 16% of HCPs reported high confidence when asked about delivering guideline-concordant care in masculine-identifying patients. Transgender patients face unique barriers to cancer care, particularly for highly gendered cancers affecting the reproductive organs. Please visit this program to learn more about how oncology HCPs can partner with transgender patients to improve oncology and primary care.

Want to Learn More?
To learn more about caring for patients with advanced endometrial cancer, please visit the CCO website often as this educational program unfolds. Upcoming activities include an update to the CCO Interactive Decision Support Tool featuring expert recommendations tailored to individual patient scenarios, along with a new series of short CME-certified text modules and downloadable slidesets capturing expert insights on the important issues in endometrial cancer care, from addressing health inequities in Black patients to integrating current and emerging therapies into care for patients with advanced disease.

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