Volume 126, Issue 12 p. 1456-1465
Epidemiology

Geographic variation in the use of lymphadenectomy and external-beam radiotherapy for endometrial cancer: a cross-sectional analysis of population-based data

B White

B White

National Cancer Registration and Analysis Service, Public Health England, London, UK

Cancer Research UK, London, UK

Joint first authors.Search for more papers by this author
A Nordin

A Nordin

National Cancer Registration and Analysis Service, Public Health England, London, UK

East Kent Hospitals University Foundation NHS Trust, Queen Elizabeth The Queen Mother Hospital, Margate, UK

Joint first authors.Search for more papers by this author
A Fry

A Fry

National Cancer Registration and Analysis Service, Public Health England, London, UK

Cancer Research UK, London, UK

Search for more papers by this author
A Ahmad

A Ahmad

Cancer Research UK, London, UK

Search for more papers by this author
S McPhail

S McPhail

National Cancer Registration and Analysis Service, Public Health England, London, UK

Search for more papers by this author
C Roe

C Roe

National Cancer Registration and Analysis Service, Public Health England, London, UK

Search for more papers by this author
B Rous

B Rous

National Cancer Registration and Analysis Service, Public Health England, London, UK

Search for more papers by this author
R Smittenaar

R Smittenaar

National Cancer Registration and Analysis Service, Public Health England, London, UK

Search for more papers by this author
J Shelton

Corresponding Author

J Shelton

Cancer Research UK, London, UK

Correspondence: J Shelton, Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD, UK. Email: [email protected]Search for more papers by this author
First published: 26 August 2019
Citations: 2

Abstract

Objective

To quantify geographic variation in the use of lymphadenectomy and/or external-beam radiotherapy (EBRT) for endometrial cancer in England.

Design

Cross-sectional analysis of population-based data.

Setting

English cancer registry data, linked to chemotherapy, radiotherapy and hospital episodes statistics data.

Population

Twenty-two thousand four hundred and eighty-three women with endometrial cancer presenting without clinical or radiological evidence of distant metastatic spread, diagnosed in England from 2013 to 2016.

Methods

Proportions of patients receiving lymphadenectomy and/or EBRT were compared across 19 Cancer Alliances, to identify variations in clinical practice. Two separate logistic regression models assessed the impact on variation of adjustment for tumour and patient characteristics.

Main outcome measures

Receipt of lymphadenectomy, receipt of EBRT.

Results

There was substantial variation by Cancer Alliance in the adjusted proportion of women with endometrial cancer receiving lymphadenectomy (range 5% [95% CI 4–6%] to 48% [95% CI 45–52%]) and EBRT (range 10% [95% CI 7–12%] to 31% [95% CI 28–33%]), after adjusting for variation in pathological grade, age, comorbidities, deprivation, ethnic group and (EBRT only) FIGO stage. Different approaches to clinical practice were identified; (i) one Cancer Alliance had significantly higher than average lymphadenectomy and significantly lower than average EBRT use, (ii) three had high use of both lymphadenectomy and EBRT, (iii) one had low lymphadenectomy use and high EBRT use, and (iv) three had low use of both lymphadenectomy and EBRT.

Conclusions

Lymphadenectomy is probably used to triage for EBRT when lymphadenectomy use is high and EBRT use is low. This is probably a result of variation in local endometrial cancer management guidelines, suggesting that UK recommendations should be clarified.

Tweetable abstract

There is geographic variation in England in the use of lymphadenectomy and radiotherapy to treat endometrial cancer.