Outcomes after the regionalization of care for high-grade endometrial cancers: a population-based study

Published: March 1, 2021
Category: Bibliography
Authors: Allan Covens, Andra Nica, Danielle Vicus, Lilian T. Gien, Quing Li, Rachel Kupets, Rinku Sutradhar, Sarah E. Ferguson
Countries: Canada
Language: English
Types: Care Management, chronic condition, Outcomes, Surgical Care
Settings: Health Plan, Specialist



In June 2013, Ontario Health (Cancer Care Ontario), the agency responsible for advancing cancer care in Ontario, Canada, published practice guidelines recommending that gynecologic oncologists at tertiary care centers manage the treatment of patients with high-grade endometrial cancers. This study examines the effects of this regionalization of care on patient outcomes.


This study aimed to evaluate the impact of the regionalization of surgery for high-grade endometrial cancer on patient and treatment outcomes.

Study Design

In this retrospective cohort study, patients diagnosed with nonendometrioid high-grade endometrial cancer from 2003 to 2017 were identified using province-wide administrative databases. To allow 6 months for knowledge translation, 2 periods were defined, with January 1, 2014, as the cutoff. Methods for segmented regression were used to test the effect of the guidelines. Multivariable Cox proportional hazards regression was used to evaluate whether regionalization of care had an impact on patient survival.


There were 3518 patients with nonendometrioid high-grade endometrial cancer identified. The case mix as represented by patient comorbidities and the disease stage distribution did not differ significantly between the 2 regionalization periods. There was a significant increase (69%–85%; P<.001) in the proportion of primary surgeries performed by gynecologic oncologists after regionalization, which was not explained by secular trends. After regionalization, the proportion of patients who had surgical staging (50%–63%; P<.001) and the proportion of patients who received adjuvant treatment (65%–71%; P<.001) increased significantly. After adjusting for age, stage, and comorbidities, there was a decrease in the hazard of mortality (hazard ratio, 0.85 [95% confidence interval, 0.73–0.99]; P=.04) after regionalization.


The publication of a regionalization policy for the treatment of high-grade endometrial cancers in Ontario led to an increase in the proportion of surgeries performed by gynecologic oncologists. This also translated into a significant improvement in patient survival.

cancer surgery,endometrial cancer,high-grade,gynecologic oncologist,regionalization,uterine cancer

Please log in/register to access.

Log in/Register

LinkedIn Facebook Twitter

© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System.
All rights reserved. Terms of Use Privacy Statement

Back to top