The Incidence of Endometrial Cancer at Waitemata District Health Board: An exploration of the risk factors and retrospective audit of patient records

Abstract

Endometrial cancer is the commonest gynaecological cancer in the developed world and is increasing at a significant rate. This increase has been largely driven by obesity and other medical conditions that have been linked to lifestyle behaviours. New Zealand is not immune to this increase with a 39% rise in cases over the past 44 years. Moreover, in New Zealand, particular ethnic groups are more at risk with marked disparities in the incidence of gynaecological cancer between Māori and Pacific women and non-Māori/Pacific women. Furthermore between 23-27% of deaths from endometrial cancer in New Zealand could be considered avoidable. Aim: This research portfolio sought to identify the incidence of endometrial cancer at Waitemata District Health Board and explore the risk factors associated with endometrial cancer. Methods: The research was conducted in two parts. In Chapter 2 an integrative review of the literature was undertaken. Searches of electronic databases including MEDLINE (Ovid SP), Cumulative Index to Nursing and Allied Heath Literature (CINAHL) and PubMed were used to locate the articles. In Chapter 3 an audit of patient records for all women diagnosed with endometrial carcinoma in a community-based hospital between 2002 and 2014 was conducted in order to: 1) determine the incidence of endometrial cancer and 2) to describe the profile of the women diagnosed with the disease at Waitemata District Health Board in relation to risk factors identified in the literature review. Results: Literature review results identified 31 relevant articles from a total of 4036 non-duplicate articles screened. Review results indicate that there are clear risk factors associated with developing endometrial cancer. A body mass index (BMI) of ≥30 kg/m² increases the risk of diagnosis for both pre- and post-menopausal women whilst the addition of metabolic syndrome and/or fertility issues compounds that risk. Results of the records audit indicated an incidence of 1.9% over the twelve year period at Waitemata DHB. There was a significant difference in the number of risk factors based on ethnicity, particularly for Māori and Pacific women who had significantly more risk factors than either NZ Europeans or ‘Other’ as a group in the study. Conclusion: The results of the literature review and retrospective audit provided evidence supporting a new model of care in Chapter 4 with the aim of improving patient experience and outcomes.