Systematic review on socioeconomic deprivation and survival in endometrial cancer

Purpose The primary objectives in this review were to (1) assess the association between socioeconomic deprivation and survival in endometrial cancer patients (2) investigate if there is an association between socioeconomic deprivation and peri-operative morbidity in endometrial cancer patients. Methods We performed a systematic review using Medline (1946-2018), Embase (1980-2018), Cinahl (1981-2018) and the Cochrane Controlled Register of Trials to identify studies that reported on the association between socioeconomic deprivation and survival or peri-operative outcomes in endometrial cancer patients. Included were adult women (age >= 18 years) diagnosed with primary endometrial cancer. Two reviewers independently selected studies and assessed bias using the Newcastle-Ottawa assessment scale. Data extraction was completed using pre-determined forms, and summary tables of evidences from the included studies were created. Results Nine studies were included in this review with a total number of 369,900 patients. Eight studies investigated survival and socioeconomic deprivation, and the majority showed that socioeconomic deprivation is associated with poorer survival in endometrial cancer patients. One study assessed the association between deprivation and peri-operative morbidity and found no difference in 30-day postoperative mortality. Conclusions Socioeconomic deprivation seems to be associated with worse survival in endometrial cancer patients, even after adjusting for stage at diagnosis. However, the impacts of important confounders such as BMI, smoking and comorbidities are unclear and should be assessed. The relationship between socioeconomic deprivation and peri-operative morbidity is unclear, and further research is needed to evaluate this aspect. A standardised measure for socioeconomic deprivation is needed in order to establish adequate comparison between studies.