With over 66,000 new cases per year, endometrial cancer (EC) is the fourth most common cancer affecting women in the United States [1]. Distressingly, it is one of the few malignancies with rising death rates [2]. Between 2008 and 2018, the incidence of endometrial cancer rose by 0.7% per year but mortality increased by 2% per year [3,4]. Additionally, the racial disparity in endometrial cancer mortality has widened, and non-Hispanic Black women die of EC at twice the rate of their non-Hispanic White counterparts despite similar disease incidence in the two groups [[5], [6], [7], [8]].

In a recent analysis of 275,000 women with endometrial cancer in the National Cancer Database, 18% of the excess relative risk of endometrial cancer mortality among non-Hispanic Black women was unexplained [9]. The treatment and sociodemographic attributes amenable to capture in the electronic medical record and databases are insufficient to explain a substantial proportion of the mortality gap. The “unknown factors” as coined by Kucera et al. (2023) may relate to the social determinants of health (SDoH) – the environmental conditions in which people live that affect health-related outcomes, including access to education and healthcare, economic stability, and neighborhood environmental exposures.

There are ongoing efforts to identify and address health-related social needs, the patient-level modifiers of the SDoH. Proposed interventions include screen-and-refer programs in which patients answer questions about their health-related social needs and are referred to resource services [10]. Even these seemingly simple interventions raise questions about equity. For instance, one institution utilized the National Comprehensive Cancer Network Distress Thermometer and Problem List, a publicly available resource for clinicians. The median distress scores recorded by the survey indicated higher distress in non-Hispanic White patients than non-Hispanic Black patients. The authors concluded that this tool led to racial disparities in referrals for support services and question whether it is an adequate assessment tool for all racial populations [11].

Currently, there is no established mechanism to assess health-related social needs in patients with endometrial cancer, nor is there an understanding of the underlying SDoH that impact endometrial cancer outcomes. Using a national database, we sought to identify and quantify the self-reported barriers to care and health-related social needs among a well described endometrial cancer cohort.