Delays to initial evaluation drive socioeconomic care disparities in endometrial cancer

Abstract

Objective: This study examines the association of socioeconomic status (SES) with delays in care and treatment timeline for endometrial cancer (EC) patients receiving primary surgery. Methods: This was a retrospective cohort study of patients who underwent surgical management of EC between 2018 and 2024. SES was determined by Area Deprivation Index (ADI) national percentile rank. Demographics, dates of symptom onset, provider visits, tissue diagnosis, and surgery were abstracted from the electronic medical record. Results: Of the 2191 patients who had surgical management for EC, we analyzed 185 (ADI1, most advantaged) and 257 (ADI4, least advantaged). Patients in ADI1 had a lower mean BMI (31.1 kg/m2 vs 35.6 kg/m2, p < 0.001). Although the majority of the cohort was White (91.0%), ADI4 included more Black patients (6.6% vs 1.1%, p = 0.003). Time from symptom onset to surgery was 30 days longer in ADI4 compared to ADI1 (126.0 days vs 96.0 days, p = 0.003). Specifically, time from symptom onset to first visit with a healthcare provider differed significantly between ADI1 and ADI4, with a median of 20.5 days versus 50.0 days (p < 0.001). There were no statistically significant differences in intervals between other care timepoints. Conclusions: The discrepancy in time to surgical management of EC was driven by delays in first provider visit, indicating that disparities are related to symptom recognition and access to initial evaluation rather than delays within specialty care. These findings can inform interventions for reducing socioeconomic and geographic disparities in endometrial cancer care.