Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study

Purpose Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient’s preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age. Methods The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology. Results Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities ( p = 0.015) or higher age ( p < 0.01). Guideline adherence was not affected by comorbidities ( p = 0.563), but was significantly reduced with higher age ( p < 0.01). In a multivariable model, higher age ( p < 0.01), obesity ( p = 0.011), higher FIGO Stage ( p < 0.01) and histologic subtype ( p < 0.01) significantly decreased OS. Surgery ( p < 0.001), chemotherapy ( p < 0.01) and systematic LNE ( p = 0.011) were associated with higher OS. Conclusion Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.