In partnership with Public Health England, we compared the proportions of patients receiving different types of treatment for endometrial cancer (lymphadenectomy and/or external beam radiotherapy (EBRT)), across 19 Cancer Alliances over 2013-2016.
To identify any variations in clinical practice of endometrial cancer treatment across different geographical areas in England.
There is variation between 19 cancer Alliances in England in the use of lymphadenectomy and radiotherapy to treat endometrial cancer.
Taking into consideration variation due to other factors, the proportion receiving a lymphadenectomy (surgical removal of lymph nodes) ranged from 5% to 48%. The proportion receiving EBRT (a common type of radiotherapy treatment) ranged from 10% to 31%.
Different approaches to clinical practice identified were:
one Cancer Alliance had significantly higher than average lymphadenectomy and significantly lower than average EBRT use
three had high use of both lymphadenectomy and EBRT
one had low lymphadenectomy use and high EBRT use
three had low use of both lymphadenectomy and EBRT
In those Cancer Alliances where lymphadenectomy use is high and EBRT use is low, lymphadenectomy is probably being used as part of staging and triage of patients for EBRT.
The variation in use of lymphadenectomy is likely due to ambiguity in local endometrial cancer management guidelines.
Patients should have access to the best treatment regardless of where they live. The findings suggest that UK guidance on the recommended use of lymphadenectomy should be clarified.
The impact of this variation on recurrence, quality of life, and disease-free and overall survival could be further explored to gauge the importance of geographic variation in lymphadenectomy and EBRT practices.
Read in full on the Obstetrics and Gynaecology hubB White, A Nordin, A Fry, A Ahmad, S McPhail, C Roe, B Rous, R Smittenaar, J Shelton.
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