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30.03.2016 | Original Article | Ausgabe 8/2016

Supportive Care in Cancer 8/2016

Race-based disparities in loss of functional independence after hysterectomy for uterine cancer

Zeitschrift:
Supportive Care in Cancer > Ausgabe 8/2016
Autoren:
Lorraine T. Dean, Xiaochen Zhang, Nawar Latif, Robert Giuntoli, Lilie Lin, Ashley Haggerty, Sarah Kim, David Shalowitz, Caitlin Stashwick, Fiona Simpkins, Robert Burger, Mark Morgan, Emily Ko, Kathryn Schmitz
Wichtige Hinweise
The abstract and results of this paper were presented in a poster presentation at the American Association for Cancer Research Annual Meeting on April 18–22, 2015 in Philadelphia, Pennsylvania. The full manuscript has never been published, in whole, to any audience or entity.

Abstract

Purpose

Racial disparities in uterine cancer-related outcomes have been reported. The goal of this study was to determine if race, pre-operative body mass index (BMI), and medical comorbidities are predictors of loss of functional independence after hysterectomy for uterine cancer.

Methods

Loss of independence was defined as a change from pre-operative functional independence, to a post-operative requirement of discharge to a post-care facility, or death within the first 30 days following uterine cancer surgery. Demographic factors, comorbidities, BMI, intra-operative and post-operative outcomes, and discharge status were abstracted from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Statistical analyses included multivariable logistic regression and Wald tests for interaction.

Results

A total of 4005 patients had uterine cancer and were functionally independent pre-operatively. After adjusting for clinical features and comorbidities, Black women were not significantly more likely to lose functional independence than non-Black women. However, a significant interaction (OR = 1.17, p < 0.001) was found between race and BMI for loss of functional independence. Interaction plots revealed worsening functional outcomes for Black women with BMI >40 but not in non-Blacks.

Conclusions

The interaction suggests a 17 % increased odds of losing independence for each unit of BMI difference for Black uterine cancer patients, or 170 % increased odds of losing independence for a 10-point increase in BMI, given a linear association. To reduce the likelihood of losing post-operative functional independence, Black, high-BMI patients with or at risk for uterine cancer may especially benefit from weight loss or interventions to optimize physical function.

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