Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Women's Health, Counties Manukau District Health Board, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2022 Oct;62(5):707-713. doi: 10.1111/ajo.13551. Epub 2022 Jun 22.
Atypical endometrial hyperplasia (AEH) is the precursor lesion in endometrial carcinoma, the most common gynaecological malignancy in New Zealand, with inequities in disease burden and outcome for Māori and Pacific women.
In women diagnosed with AEH at two hospitals, to audit five standards of care for surgical management and time-to-treatment, and identify variation in care by ethnicity and other factors.
Demographic, referral, diagnostic and treatment characteristics were collected for women with a new AEH diagnosis between 1/1/2019 and 31/12/2020. Surgical management and time-to-treatment were audited against Royal College of Obstetricians and Gynaecologists and New Zealand Ministry of Health Faster Cancer Treatment recommendations.
Of 124 participants, 60% were Pacific, 86% premenopausal, and 80% had obesity. For 55 women managed surgically, surgical standards of care were met. There were delays between referral, diagnosis and treatment - only 18% and 56% of women met the 62-day (referral to treatment) and 31-day (decision-to-treat to treatment) targets, respectively. Wait times were prolonged for women who had dilation and curettage (vs pipelle), magnetic resonance imaging (MRI) (vs no MRI), and surgery (vs medical management). Ethnic disparities were not identified for any standard.
Delays to treatment were found throughout women's journeys. Hospital services can streamline their clinical pathways for women referred for abnormal uterine bleeding, flagging obesity as a high suspicion for cancer indicator, increasing access to endometrial sampling in primary care and establishing 'one-stop-shop' outpatient assessment with empiric initiation of intrauterine progestogen.
非典型子宫内膜增生（AEH）是子宫内膜癌的癌前病变，这是新西兰最常见的妇科恶性肿瘤，毛利人和太平洋岛裔妇女的疾病负担和预后存在不平等现象。
在两家医院诊断为 AEH 的女性中，对手术管理和治疗时间的五项护理标准进行审核，并确定按种族和其他因素划分的护理差异。
收集了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间新诊断为 AEH 的女性的人口统计学、转诊、诊断和治疗特征。根据皇家妇产科医师学院和新西兰卫生部的更快癌症治疗建议，对手术管理和治疗时间进行审核。
在 124 名参与者中，60%是太平洋岛民，86%是绝经前，80%是肥胖。在接受手术治疗的 55 名女性中，有 55 名符合手术护理标准。从转诊到治疗的时间存在延迟，只有 18%和 56%的女性分别达到了 62 天（转诊到治疗）和 31 天（决定治疗到治疗）的目标。行刮宫术（与 pipelle 相比）、磁共振成像（MRI）（与无 MRI 相比）和手术（与药物治疗相比）的女性等待时间延长。任何标准都没有发现种族差异。
在女性的就诊过程中都发现了治疗延迟。医院服务可以为因异常子宫出血就诊的女性简化临床路径，将肥胖标记为癌症的高可疑指标，增加初级保健中子宫内膜取样的机会，并建立“一站式”门诊评估，同时进行经验性宫内孕激素治疗。
