Article Text

Download PDFPDF

Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study
  1. Maria C Cusimano1,
  2. Andrea N Simpson1,2,
  3. Angela Han1,
  4. Robin Hayeems3,4,
  5. Marcus Q Bernardini1,5,
  6. Deborah Robertson1,2,
  7. Sari L Kives1,2,
  8. Abheha Satkunaratnam1,
  9. Nancy N Baxter4,6,
  10. Sarah E Ferguson1,5
  1. 1 Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
  2. 2 Obstetrics and Gynaecology, St. Michael’s Hospital, Toronto, Ontario, Canada
  3. 3 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5 Gynaecology Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  6. 6 General Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Sarah E Ferguson; Sarah.Ferguson{at}


Objective Obesity is a major risk factor for low-grade endometrial cancer. The surgical management of patients with obesity is challenging, and they may face unique barriers to accessing care. We completed a qualitative study to understand the experiences of low-grade endometrial cancer patients with morbid obesity, from symptom onset to diagnosis to surgery.

Design Semi-structured interviews were performed with endometrial cancer patients with morbid obesity (body mass index (BMI) >40 kg/m2) referred for primary surgery. Transcribed interviews were coded line-by-line and analysed using an interpretive descriptive approach that drew on labelling theory to understand patients’ experiences. Thematic sufficiency was confirmed after 15 interviews.

Setting Two tertiary care centres in Toronto, Ontario, Canada.

Participants Fifteen endometrial cancer patients with a median age of 61 years (range: 50–74) and a median BMI of 50 kg/m2 (range: 44–70) were interviewed.

Results Thematic analysis identified that (1) both patients and providers lack knowledge on endometrial cancer and its presenting symptoms and risk factors; (2) patients with morbid obesity are subject to stigma and poor communication in the healthcare system and (3, 4) although clinical, administrative, financial, geographic and facility-related barriers exist, quality care for patients with morbid obesity is an achievable goal.

Conclusions Improved education on the prevention and identification of endometrial cancer is needed for both patients and providers. Delivery of cancer care to patients with morbid obesity may be improved through provider awareness of the impact of weight stigma and establishing streamlined care pathways at centres equipped to manage surgical complexity.

  • endometrial cancer
  • gynaecological oncology
  • obesity
  • surgery
  • quality in healthcare
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors Study conception and design: ANS, RH, DR, NNB and SEF; Acquisition of data: MCC, ANS, AH, MQB, DR, SLK, AS and SEF; Analysis and interpretation of data: MCC, ANS, AH and RH; Original drafting of manuscript: MCC and ANS; Critical revision of manuscript and final approval of manuscript: All authors

  • Funding This work was supported by the Department of Obstetrics and Gynecology Mount Sinai Hospital/University Health Network Research Fund, and the University of Toronto Chair’s Summer Studentship Award.

  • Competing interests None declared.

  • Ethics approval Research ethics board approval was obtained at both Princess Margaret Hospital and St. Michael’s Hospital (ID 17–5228).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The unpublished data have been de-identified and are not available to anyone other than the researchers, as per Research Ethics Board guidelines at our institutions.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.