Abstract A115: Associations between race, stress, and mortality among endometrial cancer survivors: Evidence from a national cohort

Abstract Endometrial cancer (EC) is characterized by one of the largest racial mortality disparities among all cancers in the US. Black women with EC experience approximately twice the mortality rate of White women. While differences in socioeconomic status (e.g., insurance coverage, education) and disease characteristics (e.g., stage at diagnosis, molecular subtype) partially explain this disparity, prior research indicates that a substantial portion remains unexplained. Chronic stress has been proposed as a potential contributor to many cancer outcomes. Notably, prior studies suggest that stress may differ by race among women with cancer. We hypothesized that Black women who have had a recent EC diagnosis experience higher levels of stress than their White counterparts and that elevated stress is associated with poorer overall survival in this group. To investigate this, we analyzed data from the cross-sectional National Health Interview Survey (NHIS, 1997–2018 waves), linked to the National Death Index (NDI, linked through 2019). We included all self-identified Black and White women who reported an EC diagnosis within the 5 years prior to survey (weighted Ns of 8,004 and 10,221, respectively; average years since diagnosis = 2.5). Stress was measured using the validated Kessler 6-item non-specific distress scale (K6), with scores ≥5 indicating moderate or greater distress. Overall survival, rather than cancer-specific survival, was used as the mortality endpoint due to data limitations. We first used multivariate logistic regression to examine the association between race and stress. Black women with EC had more than twice the odds of reporting moderate or greater distress compared to White (OR: 2.32, 95% CI: 1.36-3.96). After adjusting for various demographic, disease history, health behavior, and comorbidity factors potentially associated with stress, we found that age, poverty, education, physical activity, and diabetes status were significant associated with higher distress, suggesting the complexity of factors associated with stress among racially diverse women with EC. Next, we used Cox proportional hazards models to assess the association between stress and all-cause mortality. Those reporting moderate or greater distress had a 65% increased hazard of death compared to those with lower distress levels (HR: 1.67, 95% CI: 1.14–2.43), even after adjusting for potential confounders. Among the subset of Black women, the increased hazard among those with higher distress levels was even greater (HR: 3.47, 95% CI: 0.86, 13.97). In conclusion, Black women with a prior EC were significantly more likely to report elevated distress, and higher distress levels were associated with reduced overall survival. These findings underscore the potential role of stress in driving racial disparities in EC outcomes. Further research incorporating clinical disease characteristics and cancer-specific survival data is warranted to better understand these associations and inform targeted interventions. Citation Format: Anna Gottschlich, Danielle Lenz, Lara Sucheston-Campbell, Mike R. Wilson, Jamaica R. M. Robinson, Kirsten S. Purrington. Associations between race, stress, and mortality among endometrial cancer survivors: Evidence from a national cohort [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A115.