Contribution of Geographic Location to Disparities in Ovarian Cancer Treatment

Abstract

Background: More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. Patients and Methods: Women diagnosed with all stages of epithelial OC (1996–2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. Results: Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45–2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07–1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70–0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. Conclusions: Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.

Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States

“…43 We hypothesize that differences in TTD by geographic region may reflect regional differences in practice or access to care, including travel time, which has been associated with ovarian cancer treatment and outcomes. 44,45 Patients diagnosed more recently had a shorter TTD, which may reflect improved tumor antigen immunoassays and imaging, improved physician awareness, or better referral pathways developed over time. Notably, we observed no differences in TTD based on county poverty level, which may be a function of universal coverage in this database and speaks to the importance of improved insurance for all patients.…”

A qualitative study on the impact of long-distance travel for gynecologic cancer care

“…Increased distance from residence to a specialty care center may be associated with worsened survival resulting from decreased likelihood of receiving care consistent with national guidelines. This relationship appears to be particularly strong for patients with ovarian cancer ( Bristow et al, 2014 , Villanueva et al, 2019 ); however, data conflict for patients with endometrial and cervical cancers ( Gunderson et al, 2013 , Gunderson et al, 2013 , Barrington et al, 2016 , Tan et al, 2009 ).…”

Assessment of travel distance for hyperthermic intraperitoneal chemotherapy in women with ovarian cancer

“…Willingness to travel and the impact of travel distance upon outcomes have been previously evaluated in women with ovarian cancer ( Shalowitz et al, 2018 , Knisely et al, 2020 , Daruvala et al, 2021 , Stewart et al, 2014 , Bristow et al, 2015 , Villanueva et al, 2019 ). In a study by Knisely et al, including over 50,000 women diagnosed with ovarian cancer from the National Cancer Database, the median travel distance was 14.6 miles ( Knisely et al, 2020 ).…”