Racial and ethnic differences in early death among gynecologic malignancy

Background Racial and ethnic differences in early-death following cancer diagnosis have not been well studied in gynecologic malignancy. Objective To assess population-level trends and characteristics of early-death among patients with gynecologic malignancy based on race and ethnicity in the United States. Study Design The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000-2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6,843) cancers. Early-death, defined as mortality event within two months of the index cancer diagnosis, was evaluated per race and ethnicity. Results At cohort-level, early-death occurred in 21,569 (4.7%) patients, including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancer, respectively (P<0.001). In race and ethnicity-specific analysis, non-Hispanic Black (NH-Black) patients with tubo-ovarian cancer had the highest early-death rate (14.5%). Early-death racial and ethnic difference was largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for NH-Black), followed by uterine (1.6% for Asian vs 4.9% for NH-Black) and cervical (1.8% for Hispanic vs 3.8% to NH-Black) cancers (all, P<0.001). In tubo-ovarian cancer, early-death rate decreased over time by 33% in NH-Black (17.4% to 11.8%, adjusted-odds ratio [aOR] 0.67, 95% confidence interval [CI] 0.53-0.85) and 23% in NH-White (12.3% to 9.5%, aOR 0.77, 95%CI 0.71-0.85) patients, respectively; the early-death between-group difference diminished only modestly (12.3% vs 17.4% in 2000-2002, aOR for NH-White compared to NH-Black 0.54, 95%CI 0.45-0.65; and 9.5% vs 11.8% for 2018-2020, aOR 0.65, 95%CI 0.54-0.78). Conclusions Overall ∼5% of patients with gynecologic malignancy died within the first two months from cancer diagnosis, and the early-death rate exceeded 10% in NH-Black individuals with tubo-ovarian cancer. While improving early-death rates are encouraging, the difference among racial and ethnic groups remains significant calling for further evaluation.