Impact of age on the quality of care in endometrial cancer: a retrospective study of 145 patients

Objectives: Endometrial cancer is the fourth most common cancer and affects mostly the elderly. Advanced age is a poor prognostic factor but reasons are numerous and controversial. The objective of this study was to characterize the effect of age on endometrial cancer patients medical care. Materials and Methods: It was a descriptive and comparative study of a retrospective cohort of 145 patients having received care for endometrial cancer during ten years in the Gynecological Department of Saint-Etienne Hospital. The 145 patients studied were subdivided into three groups according to their age at diagnosis: < 70 (group 1), 70-79 (group 2), and > 80 (group 3). The data collected were: clinical characteristics; preoperative, operating and pathological data, and postoperative care. For each patient, the authors evaluated compliance to patient management guidelines. Results: Postmenopausal bleeding was the most common reason of first consultation and incidental diagnoses were more frequent in group 2 (13.8%). Concerning FIGO staging, there was an over-representation of Stages III and IV in group 1, while the distribution was more in favor of Stages I and II for older patients groups. No para-aortic lymphadenectomy was performed in patients from group 3 despite seven theoretical indications. This non-compliance to guidelines was detected in two-thirds of patients in group 3. Conclusion: Elderly patients from the present cohort showed less aggressive and advanced tumors compared to younger patients. Yet, they did not receive optimal surgical and adjuvant therapy according to guidelines. A multidisciplinary evaluation using standardized assessment is needed in order to help physicians in the decision-making process.