Knowledge of the risk factors and symptons associated with endometrial cancer in British South Asian and British white women

ABSTRACT Objective: To explore differences in the background knowledge of Endometrial Cancer (EC), its risk factors, symptoms and prognosis of Endometrial Cancer (EC) between British White (BW) and British South Asian (BSA) women who had undergone treatment for stage I endometrial cancer within the past 3-years. Study design: Face-to-face, semi-structured interviews exploring knowledge; diagnosis; treatment; follow-up; and survivorship were undertaken and analysed using Thematic Analysis. Results: Twenty-one women were interviewed (13 BW and 8 BSA). BW and BSA women reported similar views, experiences and concerns with regards to EC. Knowledge appeared to differ amongst the two groups with BSA women reporting being more aware that unscheduled vaginal bleeding could be associated with a malignancy but having lower levels of knowledge of the risk factors that can lead to EC, compared to BW women. There was a lack of understanding of the difference between cervical cancer and EC and as a result, many women reported taking reassurance from negative cervical cytology as excluding EC and there was also the misconception amongst some of the women that there was a link between sexual behaviour and EC. Women from both groups used the lay healthcare system to discuss their situation/symptoms, however BSA women reported to have specifically sought out women within their social network who had previously undergone treatment for EC. Conclusions: Greater effort is needed to raise awareness in both the BW/BSA communities of the symptoms associated with EC that should prompt medical review. Educational efforts are required to overcome the reported perception that EC is synonymous with cervical cancer and cannot be detected by cervical screening

Patient-Initiated Follow-Up for Low-Risk Endometrial Cancer: An cost-analysis evaluation

OBJECTIVE: Risk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up. METHODS: Women diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. The time/distance traveled by patients from their home address to the hospital clinic was calculated and used to determine patient-related costs. RESULTS: A total of 187 patients with a median of 37 (range 2-62) months follow-up after primary surgery were enrolled on the scheme. In total, the cohort were scheduled to attend 1673 appointments with hospital follow-up, whereas they only attended 69 clinic appointments and made 107 telephone contacts with patient-initiated follow-up. There was a 93.5% reduction in costs from a projected £194 068.00 for hospital follow-up to £12 676.33 for patient-initiated follow-up. The mean patient-related costs were reduced by 95.6% with patient-initiated follow-up. The total mileage traveled by patients for hospital follow-up was 30 891.4 miles, which was associated with a mean traveling time per patient of 7.41 hours and clinic/waiting time of 7.5 hours compared with 1165.8 miles and 0.46 hours and 0.5 hours, respectively, for patient-initiated follow-up. CONCLUSION: The introduction of a patient self-management follow-up scheme for low-risk endometrial cancer was associated with financial/time saving to both the patient and the healthcare economy as compared with hospital follow-up