A Triage Assessment Strategy for the Management of Women With Endometrial Cancer

Objective: This study examined a risk-factor-based assignment to either a subspecialist or a general gynaecologist for the management of women with endometrial cancer. Method: At diagnosis, all women with a diagnosis of endometrial cancer in four community hospitals were referred to a central cancer centre and stratified into low- and high-risk groups. Risk stratification was based primarily on central pathology review, with low-risk disease defined as grade 1, clinical stage 1. Women with low-risk disease were triaged back to the referring gynaecologist for surgery. Women with high-risk disease were managed at the cancer centre. The main outcome measures included risk status and pathology review, treatment and treatment location, and acceptability to patients and gynaecologists. Results: Seventy-three women participated in this pilot study between November 2009 and 2010. Risk stratification was performed in all women: 37 were classified as high risk and 36 as low risk. Ninety-seven percent of women with high-risk disease were managed at the cancer centre, and 83% of these women underwent surgical staging compared with 8% for women with low-risk disease. This approach was acceptable to both patients and gynaecologists. Conclusion: This structured pattern of care for women with endometrial cancer resulted in a shift in management, with more women managed in accordance with oncologic guidelines, meaning that women at high risk for metastases had a lymphadenectomy performed.