Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Leah M. Ferrucci

Second Advisor

Brenda Cartmel

Abstract

Background: Endometrial cancer is the most common gynecologic malignancy in the United States, with a pattern of increasing incidence and mortality. Carboplatin plus paclitaxel is the standard first-line chemotherapy regimen for patients with high-risk or advanced endometrial cancer, yet data on chemotherapy adherence in this population remain limited. Relative dose intensity (RDI), which compares delivered to recommended chemotherapy dose intensity, is an established measure of adherence across multiple cancer types. In many cancers, low RDI (typically defined as <85%) is associated with worse survival. The aim of this study was to characterize RDI and treatment modifications among endometrial cancer patients receiving first-line carboplatin plus paclitaxel at a comprehensive cancer center.Methods: We assembled a retrospective cohort of 151 patients with a first primary endometrial cancer who received first-line, curative-intent carboplatin plus paclitaxel at Yale-Smilow Cancer Hospital and its network sites between 2021 and 2023. RDI was calculated as the ratio of completed dose intensity to the National Comprehensive Cancer Network (NCCN) recommended dose intensity. Starting RDI was defined as the ratio of the oncologist prescribed dose intensity at Cycle 1 to the NCCN recommended dose intensity. We also evaluated low RDI, defined as <85%, as a dichotomous outcome and assessed variation in continuous RDI by treatment type (adjuvant, neoadjuvant, and sandwich chemoradiotherapy). Treatment modifications including dose delays, dose reductions, and early stopping were assessed as dichotomous outcomes. Results: The mean overall RDI was 88.2 ± 16.3%, with starting RDI near 98%, indicating that dose modifications accumulated over the course of treatment rather than at the initial prescription. About one-quarter (24.5%) of patients had an RDI below 85%. Dose delays, dose reductions, and early stopping occurred in 43.7%, 54.3%, and 9.9% of patients, respectively. RDI varied by treatment type, with neoadjuvant patients having the lowest mean RDI (82.2 ± 19.4%) compared to those receiving adjuvant chemotherapy (90.0 ± 15.3%) or sandwich chemoradiotherapy (87.6 ± 14.4%). Conclusion: While overall mean RDI was 88.2% in this cohort, approximately 25% of patients had an RDI below the recommended 85% threshold. Additionally, neoadjuvant patients had notably lower chemotherapy adherence (82.2%) and dose modifications were common overall. These findings provide one of the first comprehensive characterizations of RDI in endometrial cancer and highlight the need for larger studies examining predictors of low RDI and its association with survival outcomes in this growing patient population.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/16/2027

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