Mapping practice variation in early care pathways in endometrial cancer

This research study aims to investigate how early care pathways for endometrial cancer (EC) are organised and delivered across the UK, with a particular focus on how pathology and biomarker testing are integrated into first-line treatment decisions. Building on initial findings of current practices, we will map real-world practice through a structured online survey. Emerging evidence suggests significant variation in diagnostic pathways, initial treatment decisions, and MDT functioning in endometrial cancer care. A recent nationwide survey of UK clinicians found that real-world practice often diverges from guideline recommendations. Notably, while 89% of surveyed clinicians reported performing immunohistochemical testing for mismatch repair deficiency, only about 10% had access to POLE gene sequencing for molecular subtyping (George et al., 2024). Such findings highlight gaps between ideal and actual practice, potentially leading to inconsistent care. This heterogeneity may reflect system-level challenges – for instance, limited funding, laboratory capacity, or personnel to support emerging tests – which can hinder the swift adoption of new diagnostics and treatments (George et al., 2024). Indeed, a recent national audit reported significant regional variation in endometrial cancer outcomes, underscoring the need to identify and address disparities in care delivery (NDRS, 2025). In light of this, an exploration of current practices is warranted. To inform the scope of the proposed survey, GlaxoSmithKline Pharmaceuticals (GSK) conducted informal scoping interviews with four key opinion leaders (a medical oncologist, two gynaecological pathologists, and a gynaecological oncology surgeon) from across the UK. These preliminary discussions provided expert insights on current challenges and variations in the early management pathways for endometrial cancer. Clinicians described notable variation in biomarker testing workflows, interpretation of molecular findings, staging practices, MDT structure and function, and pathways for genetic assessment. They also highlighted differences in resource availability and specialist pathology support, which may contribute to variation in treatment planning and patient experience across UK centres. The input from these interviews helped shape the survey content – reinforcing the focus on how pathology results and biomarkers are integrated into treatment planning, how MDT decision-making structures operate, and what system-level barriers clinicians face in delivering guideline-aligned care. This preparatory work underlines the relevance of the research questions and ensures the survey targets areas of genuine concern in the field. The current study involves a 20-minute online self-completion survey with a sample of 100 participants. The study is observational and exploratory in nature and is not powered for formal hypothesis testing or inferential statistics. Participants will be recruited from various regions across the UK and practice settings. We aim to recruit a mix of general/gynaecological pathologists, medical oncologists, clinical oncologists, and gynaecological surgeons. The survey will include the following question types: numeric response question, single code response question, multi-code response question, Agree/Disagree statement question, frequency scale question, open-ended question, and ranking question. These question types are used to capture a variety of variables. Examples of key variables being measured are as follows: routine biomarker testing practices, perceived familiarity with biomarker testing, MDT meeting practices, personnel involved in MDT meetings, guidelines used in routine practices for care and management of primary advanced or recurrent endometrial cancer (pa/rEC) patients, lynch syndrome screening practices, personnel involved in lynch screening practices, and perceived knowledge gaps within the early pa/rEC care pathway. References George, A., Herbertson, R. A., Stillie, A., McCormack, S., Drean, A. M., Wesselbaum, A., et al. (2024). Current management practices for endometrial cancer in the UK: a national healthcare professional survey (KNOW-EC). Clinical Oncology, 36, e448–e455. doi: 10.1016/j.clon.2024.05.017 National Disease Registration Service (NDRS). (2025). Endometrial Cancer Audit Pilot – Baseline Report: Incidence, mortality and survival (2017–2019). NHS Digital. Available at: https://digital.nhs.uk/ndrs/data/data-outputs/cancer-publications-and-tools/ecap-baseline-report