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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3573-3580
Number of pages8
JournalSupportive Care in Cancer
Volume24
Issue number8
DOIs
StatePublished - Aug 1 2016

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Uterine Neoplasms
Hysterectomy
Body Mass Index
Comorbidity
Quality Improvement
Weight Loss
Logistic Models
Demography

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Dean, Lorraine T. ; Zhang, Xiaochen ; Latif, Nawar ; Giuntoli, Robert ; Lin, Lilie ; Haggerty, Ashley ; Kim, Sarah ; Shalowitz, David ; Stashwick, Caitlin ; Simpkins, Fiona ; Burger, Robert ; Morgan, Mark ; Ko, Emily ; Schmitz, Kathryn. / Race-based disparities in loss of functional independence after hysterectomy for uterine cancer. In: Supportive Care in Cancer. 2016 ; Vol. 24, No. 8. pp. 3573-3580.
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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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Dean, LT, Zhang, X, Latif, N, Giuntoli, R, Lin, L, Haggerty, A, Kim, S, Shalowitz, D, Stashwick, C, Simpkins, F, Burger, R, Morgan, M, Ko, E & Schmitz, K 2016, 'Race-based disparities in loss of functional independence after hysterectomy for uterine cancer', Supportive Care in Cancer, vol. 24, no. 8, pp. 3573-3580. https://doi.org/10.1007/s00520-016-3185-3

Race-based disparities in loss of functional independence after hysterectomy for uterine cancer. / Dean, Lorraine T.; Zhang, Xiaochen; Latif, Nawar; Giuntoli, Robert; Lin, Lilie; Haggerty, Ashley; Kim, Sarah; Shalowitz, David; Stashwick, Caitlin; Simpkins, Fiona; Burger, Robert; Morgan, Mark; Ko, Emily; Schmitz, Kathryn.

In: Supportive Care in Cancer, Vol. 24, No. 8, 01.08.2016, p. 3573-3580.

Research output: Contribution to journalArticle

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T1 - Race-based disparities in loss of functional independence after hysterectomy for uterine cancer

AU - Dean, Lorraine T.

AU - Zhang, Xiaochen

AU - Latif, Nawar

AU - Giuntoli, Robert

AU - Lin, Lilie

AU - Haggerty, Ashley

AU - Kim, Sarah

AU - Shalowitz, David

AU - Stashwick, Caitlin

AU - Simpkins, Fiona

AU - Burger, Robert

AU - Morgan, Mark

AU - Ko, Emily

AU - Schmitz, Kathryn

PY - 2016/8/1

Y1 - 2016/8/1

N2 - 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.

AB - 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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