Ashley S. Felix

American Community Survey (ACS) datasets used to derive area-level socioeconomic variables by data source and diagnosis year

Background:Guideline-concordant treatment (GCT) is a key indicator of cancer care quality, yet most studies rely on cancer registry data, which incompletely capture treatment adequacy and vary in population composition. As a result, estimates of racial and ethnic disparities in GCT may differ depending on treatment measurement and populations represented in the data. Methods:We conducted analyses using Surveillance, Epidemiology, and End Results (SEER) 17, the National Cancer Database (NCDB), and SEER–Medicare to evaluate how treatment measurement and population composition influence disparities in guideline-concordant endometrial cancer treatment. GCT was defined according to National Comprehensive Cancer Network recommendations. Primary analyses used adequacy-based definitions incorporating treatment receipt, timing, amount, and duration, when available, whereas sensitivity analyses used receipt-based definitions based only on documented receipt. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and GCT within each data source. Additional sensitivity analyses evaluated influences of differences in underlying study populations. Results:Using adequacy-based definitions of GCT, Black patients had lower GCT odds than White patients (SEER OR = 0.84; 95% CI, 0.79–0.90; NCDB OR = 0.75; 95% CI, 0.73–0.77; SEER–Medicare OR = 0.73; 95% CI, 0.62–0.85). Within both NCDB and SEER–Medicare, adequacy-based definitions of GCT yielded larger racial and ethnic disparities than receipt-based definitions. Conclusions:The estimated magnitude of racial disparities in guideline-concordant endometrial cancer treatment is sensitive to treatment measurement and patient selection; sources capturing treatment adequacy show larger disparities. Impact:Measuring treatment adequacy provides a more comprehensive assessment of inequities in endometrial cancer care and may improve cancer disparity research, quality measurement, and policy.

These supplementary methods describe the operational definitions used to classify guideline-concordant endometrial cancer treatment in the NCDB and SEER-Medicare datasets.

Codes used to identify treatments in SEER, NCDB, and Medicare claims

Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between all model covariates and guideline-concordant treatment stratified by data source

Multivariate-adjusted odds ratios and 95% confidence intervals for association between race and guideline-concordant treatment receipt stratified by SES characteristics

Background: Guideline-concordant treatment (GCT) is a key indicator of cancer care quality, yet most studies rely on cancer registry data, which incompletely capture treatment adequacy and vary in population composition. As a result, estimates of racial and ethnic disparities in GCT may differ depending on treatment measurement and populations represented in the data. Methods: We conducted analyses using Surveillance, Epidemiology, and End Results (SEER) 17, the National Cancer Database (NCDB), and SEER–Medicare to evaluate how treatment measurement and population composition influence disparities in guideline-concordant endometrial cancer treatment. GCT was defined according to National Comprehensive Cancer Network recommendations. Primary analyses used adequacy-based definitions incorporating treatment receipt, timing, amount, and duration, when available, whereas sensitivity analyses used receipt-based definitions based only on documented receipt. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and GCT within each data source. Additional sensitivity analyses evaluated influences of differences in underlying study populations. Results: Using adequacy-based definitions of GCT, Black patients had lower GCT odds than White patients (SEER OR = 0.84; 95% CI, 0.79–0.90; NCDB OR = 0.75; 95% CI, 0.73–0.77; SEER–Medicare OR = 0.73; 95% CI, 0.62–0.85). Within both NCDB and SEER–Medicare, adequacy-based definitions of GCT yielded larger racial and ethnic disparities than receipt-based definitions. Conclusions: The estimated magnitude of racial disparities in guideline-concordant endometrial cancer treatment is sensitive to treatment measurement and patient selection; sources capturing treatment adequacy show larger disparities. Impact: Measuring treatment adequacy provides a more comprehensive assessment of inequities in endometrial cancer care and may improve cancer disparity research, quality measurement, and policy.

Codes used to identify treatments in SEER and Medicare claims

Yearly prevalence of A.) hysterectomy with or without BSO, B.) hysterectomy with BSO, C.) lymphadenectomy, D.) EBRT, E.) VBT, and F.) Chemotherapy by data source