Patient reported outcomes in women with type I and type II uterine cancer: a pragmatic prospective study

Objectives: The objective of this pragmatic study was to describe patient reported outcomes (PROs) in a routine clinic population with Type I and Type II uterine cancers over the course of their disease management. Methods: PROs were collected prospectively at a tertiary care gynecologic oncology center beginning in 2018 using validated tools (PROMIS, EORTC EN-24, and EORTC QLQ-C30). Responses were compared using Chi-square, independent T-tests, and binary logistic regressions (controlling for Type I vs. II cancer, insurance, stage, age, time since diagnosis, recurrence, and race). Results: There were 247 women with uterine cancer included, 216 of whom responded to the PROs (87.4% response rate). Responders were not significantly different from non-responders apart from being slightly younger (mean age 64.9 vs. 68.9; p=0.049). Baseline characteristics differed for women with Type II uterine cancer compared to Type I in expected ways (higher stage, older age, higher recurrence rate, higher rates of adjuvant therapy). Women with Type II cancers were significantly burdened by their disease, reporting higher rates of social (22.4% vs. 8.2%; p=0.002) and family life (12.1% vs. 3.2%; p=0.008) interference and higher rates of adverse outcomes on the QLQ-C30 instrument (Figure). On adjusted analyses, women with Type II uterine cancer reported higher rates of suffering, specifically citing trouble taking short walks outside the house (aOR 27.43, 95% CI 3.16-237.90; p=0.003), feeling limited in their work/daily activities (aOR 4.04, 95% CI 1.48-11.02; p=0.006), being limited in pursuing their hobbies (aOR 3.79, 95% CI 1.31-10.99; p=0.014), and feeling irritable (aOR 4.37, 95% CI 1.11-17.30; p=0.036) after controlling for recurrence, stage, and other confounders. Publicly insured women were less likely to have someone to help if they were bedbound (aOR 2.48, 95% CI 1.05-5.85; p=0.038) and reported overall poorer quality of life (aOR 8.74, 95% CI 2.81-27.18; p<0.001). Non-White women were more likely to report trouble with strenuous activity (aOR 5.19, 95% CI 2.07-13.00; p<0.001) and taking long walks (aOR 7.37, 95% CI 2.86-19.00; p<0.001). Overall, stage and recurrence were not associated with significant differences on the majority of PROs. Conclusions: Uterine cancer patients with Type II cancers and public insurance suffer more during their treatment and survivorship. These data are important because by understanding what types of adverse outcomes different women experience, gynecologic oncologists can more effectively alleviate suffering for the patients they care for. The objective of this pragmatic study was to describe patient reported outcomes (PROs) in a routine clinic population with Type I and Type II uterine cancers over the course of their disease management. PROs were collected prospectively at a tertiary care gynecologic oncology center beginning in 2018 using validated tools (PROMIS, EORTC EN-24, and EORTC QLQ-C30). Responses were compared using Chi-square, independent T-tests, and binary logistic regressions (controlling for Type I vs. II cancer, insurance, stage, age, time since diagnosis, recurrence, and race). There were 247 women with uterine cancer included, 216 of whom responded to the PROs (87.4% response rate). Responders were not significantly different from non-responders apart from being slightly younger (mean age 64.9 vs. 68.9; p=0.049). Baseline characteristics differed for women with Type II uterine cancer compared to Type I in expected ways (higher stage, older age, higher recurrence rate, higher rates of adjuvant therapy). Women with Type II cancers were significantly burdened by their disease, reporting higher rates of social (22.4% vs. 8.2%; p=0.002) and family life (12.1% vs. 3.2%; p=0.008) interference and higher rates of adverse outcomes on the QLQ-C30 instrument (Figure). On adjusted analyses, women with Type II uterine cancer reported higher rates of suffering, specifically citing trouble taking short walks outside the house (aOR 27.43, 95% CI 3.16-237.90; p=0.003), feeling limited in their work/daily activities (aOR 4.04, 95% CI 1.48-11.02; p=0.006), being limited in pursuing their hobbies (aOR 3.79, 95% CI 1.31-10.99; p=0.014), and feeling irritable (aOR 4.37, 95% CI 1.11-17.30; p=0.036) after controlling for recurrence, stage, and other confounders. Publicly insured women were less likely to have someone to help if they were bedbound (aOR 2.48, 95% CI 1.05-5.85; p=0.038) and reported overall poorer quality of life (aOR 8.74, 95% CI 2.81-27.18; p<0.001). Non-White women were more likely to report trouble with strenuous activity (aOR 5.19, 95% CI 2.07-13.00; p<0.001) and taking long walks (aOR 7.37, 95% CI 2.86-19.00; p<0.001). Overall, stage and recurrence were not associated with significant differences on the majority of PROs. Uterine cancer patients with Type II cancers and public insurance suffer more during their treatment and survivorship. These data are important because by understanding what types of adverse outcomes different women experience, gynecologic oncologists can more effectively alleviate suffering for the patients they care for.