Disparities in not recommending chemotherapy for individuals with newly diagnosed advanced endometrial cancer due to “patient risk factors”

• NCCN guidelines recommend systemic chemotherapy for frontline treatment of stage III/IV endometrial cancer. • In the NCDB (2004–2021), for 2.1% of such patients, chemotherapy was not recommended due to “patient risk factors”. • Increasing age, Black race, less education, and no or government insurance were associated with not recommending chemo. We sought to identify patient sociodemographic characteristics associated with not recommending chemotherapy due to “patient risk factors” for individuals diagnosed with advanced-stage endometrial cancer. Methods: We conducted a retrospective analysis of individuals newly diagnosed with stage III or IV endometrial cancer 2004–2021 utilizing the National Cancer Database (NCDB). The primary outcome was indication that “chemotherapy was not recommended/administered because it was contraindicated due to patient risk factors (i.e., comorbid conditions, advanced age […])” compared to chemotherapy recommended, regardless of administration. A logistic regression model examined associations between patient sociodemographic characteristics (age, race, ethnicity, education, type of insurance, urban/rural residence) and not recommending chemotherapy due to patient risk factors, adjusting for clinical factors including Charlson-Deyo comorbidity index scores, stage, histology, grade, and facility type. Among the 96,497 individuals included in the analysis, chemotherapy was not recommended for 2,030 (2.1%) due to “patient risk factors.” Increasing age, Black race, living in a zip code with less prevalent high school completion, and having no insurance or government insurance were independently associated with chemotherapy not being recommended after adjusting for clinical variables. Sensitivity analyses excluding subgroups more likely to have clinical contraindications, including those who did not have surgery, had a Charlson-Deyo comorbidity index score > 0, or died within 30 days of surgery found similar results. Despite National Comprehensive Cancer Network guidelines recommending chemotherapy for frontline treatment of advanced stage endometrial cancer, disparities in recommendations for chemotherapy were observed by sociodemographic factors including race, age, education, and insurance status.