Among women with early-stage endometrial cancer (EC), age, stage, grade, and histology are used to determine fitness for adjuvant radiation therapy (RT) administration. We examined non-cancer factors associated with adjuvant RT receipt in older women with early-stage EC. Using data from the Surveillance Epidemiology and End Results cancer registry program linked with Medicare claims, we identified 25,654 women (aged ≥66 years) diagnosed with first primary stage I-II EC during 2004–2017 who underwent a hysterectomy. Diagnosis and procedure codes were used to identify adjuvant RT claims filed for the seven-month period post-hysterectomy. Multivariable log-binomial regression was used to estimate adjuvant RT prevalence associated with patient characteristics and health system factors after adjustment for age, frailty, and endometrial factors. Adjuvant RT was less commonly administered to Asian American and Pacific Islander patients than non-Hispanic White patients (Prevalence ratio [PR], 0.84; 95% confidence interval [CI], 0.73 to 0.97). Compared to women treated in the Northeast region, women treated other regions of the US were less likely to undergo adjuvant RT (PR, 0.75; 95% CI, 0.71 to 0.79). Residing in rural or high neighborhood-poverty counties was associated with lower adjuvant RT administration. Higher comorbidity score was not associated with reduced prevalence of adjuvant RT receipt; however, women with high probability of predicted probability of frailty were less likely to undergo adjuvant RT (PR, 0.67; 95% CI, 0.55 to 0.81) compared to women with low probability of frailty. Women who received lymph node assessment were more likely to undergo adjuvant RT compared to women who did not (PR, 1.43; 95% CI, 1.34 to 1.51). Women treated by a gynecologic oncologist were more likely to undergo adjuvant RT compared to women treated by a non-gynecologic oncologist (PR 1.09; 95% CI, 1.04 to 1.14). Adjuvant RT was more commonly administered to women treated in larger academic hospitals. Findings suggest that various non-cancer factors affect the delivery of adjuvant RT to older women with early-stage EC in real-world oncology practice. Advancing our understanding of factors associated with adjuvant RT administration may help expand equitable access to RT.

中文翻译：

---

患有早期子宫内膜癌的老年女性接受辅助放射治疗的患者特征和卫生系统因素


在患有早期子宫内膜癌 (EC) 的女性中，年龄、分期、分级和组织学用于确定是否适合辅助放射治疗 (RT)。我们研究了与早期 EC 老年女性接受辅助放疗相关的非癌症因素。利用与医疗保险索赔相关的流行病学监测和最终结果癌症登记计划的数据，我们确定了 2004 年至 2017 年期间被诊断患有第一期原发性 I-II 期 EC 并接受子宫切除术的 25,654 名女性（年龄≥66 岁）。诊断和程序代码用于识别子宫切除术后七个月期间提交的辅助 RT 索赔。在调整年龄、虚弱和子宫内膜因素后，使用多变量对数二项式回归来估计与患者特征和卫生系统因素相关的辅助放疗患病率。与非西班牙裔白人患者相比，亚裔美国人和太平洋岛民患者较少接受辅助放疗（患病率 [PR]，0.84；95% 置信区间 [CI]，0.73 至 0.97）。与东北地区接受治疗的女性相比，美国其他地区接受治疗的女性接受辅助放疗的可能性较小（PR，0.75；95% CI，0.71 至 0.79）。居住在农村或高贫困县与较低的辅助 RT 管理相关。较高的合并症评分与辅助 RT 接受率降低无关；然而，与虚弱概率低的女性相比，预测虚弱概率高的女性接受辅助 RT 的可能性较小（PR，0.67；95% CI，0.55 至 0.81）。与未接受淋巴结评估的女性相比，接受淋巴结评估的女性更有可能接受辅助放疗（PR，1.43；95% CI，1.34 至 1.51）。 与接受非妇科肿瘤科医生治疗的女性相比，接受妇科肿瘤科医生治疗的女性更有可能接受辅助放疗（PR 1.09；95% CI，1.04 至 1.14）。辅助放疗更常见于在大型学术医院接受治疗的女性。研究结果表明，在现实肿瘤学实践中，各种非癌症因素会影响早期 EC 老年女性接受辅助放疗的情况。加深我们对辅助放疗相关因素的理解可能有助于扩大放疗的公平可及性。