Grant Number:	5R37CA266204-04 Interpret this number
Primary Investigator:	Felix, Ashley
Organization:	Ohio State University
Project Title:	Understanding Multilevel Drivers of Gaps in Guideline-Concordant Endometrial Cancer Treatment in High-Risk Populations
Fiscal Year:	2025

Endometrial cancer (EC) demonstrates significant variation in outcomes across patient populations. Receipt of treatment in line with national recommendations is an important modifiable factor that influences EC outcomes. The National Comprehensive Cancer Network recommends surgical staging as the first step of guideline-concordant treatment and pathology factors captured from surgery inform adjuvant treatment recommendations. Our prior work demonstrates that receipt of guideline-concordant EC treatment improves survival. Therefore, observed differences in receipt of such treatment across populations is concerning and contributes to suboptimal disease outcomes. We lack a comprehensive understanding of the multilevel determinants that underlie variation in guideline-concordant EC treatment, preventing any meaningful progress in evidence-based intervention development. The extant literature has exclusively focused on individual-level factors as predictors of guideline-concordant EC treatment, which has not led to sustained improvement in care delivery. In addition, even within guideline-concordant paradigms, there can be wide variation in intensity level of recommended treatments, with markedly different impact on quality of life. The factors influencing intensity of treatment within guideline-concordant paradigms are poorly understood. Most important, there are no qualitative data to understand how patients and providers navigate decision-making regarding EC treatment, particularly in populations at increased risk of receiving non-guideline-concordant care. Absent these critical building blocks, we cannot move forward with evidence-based interventions to improve guideline-concordant EC treatment receipt. We propose to identify determinants of variation in guideline-concordant EC treatment by combining analysis of multilevel data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims linked dataset (Aims 1-2) with in-depth interviews of women with EC and EC providers (Aim 3). Aim 1: Identify multilevel factors that predict differences in receipt of guideline-concordant EC treatment. Aim 2: Quantify variation and underlying predictors of guideline-concordant EC treatment intensity and examine associations between guideline-concordant EC treatment intensity and survival. Aim 3: Examine the multilevel dynamics that drive and constrain treatment decision-making using qualitative methods. By analyzing a high-quality, multilevel dataset and capturing first-hand accounts of treatment experiences and preferences, our team will uncover actionable factors that can be targeted to improve care delivery and outcomes for all women.





None