Older adults with cancer are severely underrepresented in clinical trials where standard oncological treatment regimes are established. In this retrospective population-based study, we seek to clarify whether older women with endometrial cancer 1) are offered standard treatment to the same extent as younger women, 2) are able to complete standard treatment, and 3) have the same effect of treatment in terms of comparable survival as younger patients.
Endometrial cancer (EC) is the 7th most common type of cancer amongst women in Denmark (2019) and the most common gynecological cancer, with an annual incidence of around 750-800. Like most other cancer types, the incidence rises as life expectancy increases. EC is considered rare before the age of 45 years (<20 pr. 100.000), and the highest incidence is around 75-80 years (3-5). The etiology is multifactorial, and non-genetic risk factors strongly associated with developing EC include obesity, nulliparity, and diabetes mellitus (DM). Endometroid adenocarcinoma (type 1) is the most dominant type of EC and accounts for around 80% of all cases. Others include serous, clear-cell, and undifferentiated adenocarcinomas.
EC patients are divided into risk groups and treated accordingly based on the FIGO tumor stage and the tumor's distinctive pathology and molecular profile. High-risk include adenocarcinoma stage III-IVA and serous, clear-cell, and undifferentiated adenocarcinoma stage I-IVA. Patients with a high-risk EC should be offered adjuvant chemotherapy, which consists of combination chemotherapy with six cycles of carboplatin and paclitaxel (TC). Although EC has a high overall 5-year survival rate of around 83%, the 5-year survival rate for stage III is only approximately 40% in Denmark. Furthermore, 60% of women who die from EC are older than 70 years.
Aging is a multidimensional and highly individualized process involving an increasing prevalence of comorbidities and polypharmacy, as well as physiological changes that can modify the pharmacokinetics and pharmacodynamics of drugs. Despite an increasing incidence of older adults with cancer, they remain underrepresented in clinical trials determining standard cancer care and representing a therapeutic challenge. To support clinical decisions, it is crucial to identify older adults at greater risk of developing toxicity without compromising efficacy. Additionally, increased quality of life might be more important to older adults than increasing survival and should be considered when choosing treatment.
Therefore, in this study, I seek to evaluate how age and age-related comorbidities impact overall survival (OS). Furthermore, I seek to assess if older adults are 1) less likely to be offered standard treatment and 2) less likely to adhere to standard treatment. Lastly, I wish to evaluate how the choice of treatment and adherence to standard treatment affects OS and disease-free survival and progression-free survival regarding EC patients receiving adjuvant and palliative oncological treatment, respectively.
Description of the cohort
The study consists of a national cohort of patients diagnosed with EC from 2015-2019 and a subpopulation (regional cohort) of these patients referred for oncological treatment at Odense University hospital (OUH). These data will be granted from The Danish Gynecological Cancer Database (DGCD) and the oncology department at OUH, respectively.
Patients in the regional cohort will be divided into an Adjuvant Patient Group and a Palliative Patient Group based on their diagnoses and treatment plan.
Data and biological material
Data will include variables from DGCG, such as patient age, tumor stage, tumor histopathology, Anesthesiologists (ASA) score, date of diagnosis, date and extent of surgery, and postoperative complications. In addition, data from patients treated at the oncology department at OUH, will be collected based on patients' journals. These data will include general patient characteristics, treatment data, treatment plan and adherence to treatment, recurrence, and mortality.
Regarding biological material, histopathology will be included.