Following on from the publication of a baseline report last year, the Endometrial Cancer Audit Pilot (ECAP) has published its second national report, focusing on the treatments received by women diagnosed with endometrial cancer in England between 2017 and 2019.
This second report concerns the analysis of routinely collected health data and describes the use of hysterectomy (removal of the womb), chemotherapy and radiotherapy. It also assesses whether existing data sources can reliably capture information on lymph node assessment and hormone (endocrine) therapy.
Endometrial cancer is the most common gynaecological cancer in the UK. While clinical guidelines outline recommended approaches to treatment, there is limited evidence at a national level on how care is delivered in practice and how this varies between patient groups and regions.
Key findings
Treatment patterns varied by both patient characteristics and tumour features.
Women without additional health conditions were more likely to receive surgery, chemotherapy or radiotherapy. Treatment use varied across age groups, with the highest use in the middle age groups and lowest use among the youngest and oldest women. Treatment rates also varied by socioeconomic deprivation and ethnic group. This suggests that some differences in care may not be fully explained by clinical need alone.
Stage at diagnosis was a key factor. The use of surgery was higher among patients diagnosed with stage 1-3A cancers, while chemotherapy was more commonly used among patients diagnosed at later stages and radiotherapy was used primarily among patients diagnosed with stage 2-3 cancers.
Even after accounting for patient demographics and tumour characteristics likely to be associated with treatment options and decision-making, treatment rates were lower than expected within some regions, particularly in rates of hysterectomy and chemotherapy. Women diagnosed in hospitals with a specialist gynaecological cancer centre were more likely to receive treatment.
Among women who received treatment, there was also variation in the type of hysterectomy performed, whether chemotherapy was given before or after surgery, the type of radiotherapy used, and the combinations of treatments women received.
Data quality and completeness
The report highlights some limitations in routine data capture. Recording of codes used to record lymph node assessment or treatment was lower than expected, although analysis of more recent data up to 2022 suggests that recording has improved over time. Recorded use of hormone (endocrine) therapy was lower than anticipated, indicating the need for continued improvements in data completeness.
Why this matters
Understanding real-world treatment patterns is essential for identifying unwarranted variation, improving equity of care and supporting service planning. This report represents an important step towards a potential future national endometrial cancer audit.
Acknowledgement
This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS England.