Table 2

Representative quotations illustrating the four major themes of the study

ThemeInterviews raised, n (%)Representative quotations
Patients and providers lack knowledge on endometrial cancer15 (100%)“At that time, I didn’t even know there was such a thing as endometrial cancer, or uterine cancer (ID 3).”
“You know, it never dawned on me that [the bleeding] would, you know… would be cancer or anything like that (ID 14).”
“Anyone I spoke to about [bleeding] said, oh it’s happened to me before too. Stuff like that. So I didn’t have any concerns (ID 5).”
“I didn’t really think about cancer, honestly. I was worried about becoming anemic. Or, you know, just getting the bleeding stopped, because sometimes you’d be out, or, I’d go to work and I’d get out of my vehicle and I’d just have a gush and I’d have to come back home again and get changed. So, I started to not go places. But I never thought about it being cancer to tell you the truth (ID 12).”
“I would say I first brought [the bleeding] to my doctor’s attention in 2009. She told me that it was perimenopause (ID 3).”
“My family doctor told me [the bleeding was due to] endometriosis. He said it is not cancer. And when I did the biopsy, he said it’s only endometriosis. He said it’s not cancer, I wouldn’t worry if I were you. And, the results came back and it was cancer (ID 2).”
“I went to see my family doctor… and he said I had a bladder infection (ID 13).”
“When you have a woman who is bleeding beyond the normal time and she has risk factors for endometrial cancer, please suggest a biopsy. Do it in a timely fashion. Don’t wait until she’s beside herself. That would be one message. It’s pretty egregious that that needs to be said. But maybe just a general reminder (ID 3).”
Obese endometrial cancer patients are subject to stigma and poor provider communication12 (80%)“He said—‘Why would you want to carry around 400 pounds? Were you like that all your life?’ And, I’m telling you this just happened to me not a month and a half ago. Sure, I know I’m overweight. I know I’m morbidly obese, if that’s what you want to say (ID 7).”
“It’s made me very angry and disgusted with myself. Cause, you know, it’s like I have brought this problem on myself, even though I know that people who are not obese could still get this (ID 6).”
“She didn’t like to deal with me because of my body weight. That’s pretty much how I ended up in Toronto (ID 15).”
“The thing is, you’ve got your good nurses and you’ve got your good helpers and all that. And, then you get the one that spoils… you know, sometimes you get that bad apple in the barrel. And that was not a good experience for me (ID 13).”
“There was a comment when I went initially, when I was hemorrhaging, that it was hard to examine me because, you know, I was so big. You have to understand, being an obese woman, you don’t want to get up on that table. You don’t want anybody to see you with your clothes off (ID 2).”
“She was back in hospital on a vacuum wound dressing and they were still trying to get her up and admonishing her and berating her, as if she were a lazy fat old woman that didn’t want to cooperate in her own care. Two days before she died, they were still admonishing her to get up and walk those stairs and do this and that (ID 3).”
“When I’ve been thin, my treatment has differed vastly. Absolutely. I feel the gynecologist absolutely judged me. She totally berated me for my weight. Totally made it my fault that I had this illness and the subtext was, you know, you brought this on yourself and we’ll try to help you as best you can… as best we can, but, you know, it’s your doing (ID 3).”
“It’s not like they’re going to come out and say, oh yeah, because of your weight, we’re not doing this, that, and the other thing. They’re not going to just come out and say that (ID 10).”
Potentially modifiable barriers to care exist for obese endometrial cancer patients14 (93%)“I waited… I think I waited something like 3 weeks. And, then the next thing I heard was that I was being referred to another doctor and I was thinking, this is nonsense. He told me he was going to do the surgery (ID 3).”
“He said he would refer me to somebody else to do it laparoscopically. But, you know, he didn’t know when it would happen. And I just wanted it out. I just wanted it over and done with. I didn’t want to be waiting around (ID 7).”
“I was waiting, waiting, waiting [to see the second surgeon] (ID 6).”
“And then after [the surgery was abandoned], I went to see her at the office and she said, ‘I couldn’t do it. It was too dangerous with your other organs there and that, it wasn’t advisable.’ So anyway, she said, ‘In my opinion’ she said, ‘I’m going to refer you to Princess Margaret and if it were me, I would want to do the robotic arm.’ She said, ‘That was your best bet’ (ID 13).”
“She wanted to go ahead and do a hysterectomy. But the anesthetist said, ‘No, it can’t be done here.’ And that started a whole other process (ID 11).”
Quality care for obese endometrial cancer patients can be an achievable goal14 (93%)“In Toronto they were more positive and upbeat. It was like, you know—here we can do something (ID 15).”
“Everybody in that operating room was just so… it was like watching every scene in motion. Everything was in tune. Everything was like, worked proficiently, you know. It was like amazing. The team work was just absolutely amazing (ID 2).”
“I think they do a marvellous job. I really do (ID 12).”
“I was amazed. I really was. And I tell people— listen if anything ever goes wrong like that, make sure they send you down to Princess Margaret (ID 4).”
“Cancer is cancer, whether you’re fat, thin, tall or short. You should be treated the same way. I didn’t feel that being overweight was, uh…that they were looking at me differently (ID 5).”
“I think that they’re doing a great job and I think that they need to continue what they’re doing. I couldn’t have asked for anyone better. Even the people that were not in the medical field were very helpful and that goes a long way (ID 7)."