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Evaluating equity of access and predictors of minimally invasive hysterectomy for endometrial and cervical cancer from 2000 to 2017 in Ontario, Canada: A population-based cohort study.
McGinnis, Justin M; Pond, Gregory R; Reade, Clare J; Schnarr, Kara L; Simunovic, Marko; Elit, Lorraine M; Seow, Hsien-Yeang; Helpman, Limor.
Afiliação
  • McGinnis JM; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
  • Pond GR; Juravinski Hospital and Cancer Centre, Escarpment Cancer Research Institute, Hamilton, Ontario, Canada.
  • Reade CJ; Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
  • Schnarr KL; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
  • Simunovic M; Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
  • Elit LM; Juravinski Hospital and Cancer Centre, Escarpment Cancer Research Institute, Hamilton, Ontario, Canada.
  • Seow HY; Department of Surgery, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
  • Helpman L; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
J Surg Oncol ; 129(2): 392-402, 2024 Feb.
Article em En | MEDLINE | ID: mdl-37750346
INTRODUCTION: We sought to assess the uptake of minimally invasive hysterectomy among patients with endometrial and cervical cancer in Ontario, Canada, and assess the equity of access to minimally invasive surgery (MIS) by evaluating associations with patient, disease, institutional, and provider factors. METHODS: This is a retrospective population-based cohort study of hysterectomy for endometrial and cervical cancer in Ontario (2000-2017). Surgical approach, clinicopathologic, sociodemographic, institutional, and provider factors were identified through administrative databases. Fisher's exact, χ2 , Wilcoxon rank sum, logistic regression, and Cox proportional hazards modeling were used to explore factors associated with MIS. RESULTS: A total of 27 652 patients were included. In total, 6199/24 264 (26%) endometrial and 842/3388 (25%) cervical cancer patients received MIS. The proportion of MIS to open surgeries increased from <0.1% in 2000 to over 55% in 2017 (odds ratio [OR] = 1.31, confidence interval [CI] = 1.28-1.34). Low-income quintile, rurality, low hospital volume, nonacademic hospital, nongynecologic oncology surgeon, and earlier year of surgeon graduation were associated with reduced odds of MIS (OR < 1). CONCLUSIONS: The uptake of MIS hysterectomy increased steadily over the time period. Receipt of MIS is dependent upon multiple social determinants, provider variables, and systems factors. These disparities raise concern for health equity in Ontario and have significant implications for health systems planning and resource allocation.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Colo do Útero Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Colo do Útero Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article