Disparities in Use of Gynecologic Oncologists for Women with Ovarian Cancer in the United States

Austin, Shamly; Martin, Michelle Y.; Kim, Yongin; Funkhouser, Ellen; Partridge, Edward E.; Pisu, Maria

doi:10.1111/1475-6773.12012

Cited by 13 publications

(5 citation statements)

References 45 publications

(75 reference statements)

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“…Data from a single state cancer registry study by Chan et al [ 14 ] showed that women with OC under the care of GOs were more likely to receive appropriate staging and chemotherapy treatments, controlling for age, stage, and grade of disease. Also similar to previous studies, our results suggest that greater utilization of GOs in the care of OC patients would be beneficial [ 22 ] . Although the level of detail in our analysis is unable to discriminate the factors underlying the low utilization, it is likely that our results reflect a complex interaction of both preference and access-relevant effects, such as the influence of a patient’s choice in receipt of GO care vs a shortage of available GOs in some areas.…”

Section: Discussionsupporting

confidence: 90%

Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival

Rim¹,

Hirsch²,

Thomas³

et al. 2016

WJOG

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AIMTo examine the influence of gynecologic oncologists (GO) in the United States on surgical/chemotherapeutic standard of care (SOC), and how this translates into improved survival among women with ovarian cancer (OC).METHODSSurveillance, Epidemiology, and End Result (SEER)-Medicare data were used to identify 11688 OC patients (1992–2006). Only Medicare recipients with an initial surgical procedure code (n = 6714) were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Multivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.RESULTSAbout 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC (P < 0.01). Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22 (95%CI: 1.12–1.33), P < 0.01], and also was higher among women seen by non-GOs vs GOs (for surgical treatment) after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC.CONCLUSIONA survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.

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Section: Discussionsupporting

confidence: 90%

Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival

Rim¹,

Hirsch²,

Thomas³

et al. 2016

WJOG

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“…The age group of women 65 years old and older is particularly vulnerable to this cancer: incidence rates are 6 times and mortality rates are 13 times higher in the older population than in women younger than 65 [1]. The advances in treatment have improved the prognosis for ovarian cancer; however, not all women diagnosed with this disease, in particular older women, receive care congruent with current evidence-based guidelines, including the National Comprehensive Cancer Network (NCCN) guidelines [1–4]. …”

Section: Introductionmentioning

confidence: 99%

Values and worries of ovarian cancer patients

Pisu

Kenzik

Rim

et al. 2017

Gynecologic Oncology

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Introduction Older women with ovarian cancer (OC) are less likely to receive guideline concordant treatment. Differences in values and worries about treatment may explain why. Methods Women with OC in 2013–2015 were surveyed about values and worries at the time of initial treatment. Existing values (11 item, e.g., maintaining quality of life) and worries (12 items, e.g., treatment side effects) scales were adapted based on OC literature. Responses were very/somewhat/a little/not at all important or worried. Principal Component Analyses (PCA) identified groups of values and worries that best explained scales' variation. We examined proportions reporting very/somewhat important/worried on ≥1 item in each component by age (older ≥65 years, younger <65 years). Results Of 170 respondents, 42.3%were older. PCA components for values were: functional well-being (3 survey items, proportion of variance explained [PoVE] 26.3%), length of life and sexual functioning (3 items, PoVE 20.1%), attitudes (3 items, PoVE 14.2%), and not becoming a burden (2 items, PoVE 13.7%). PCA components for worries were: economic (4 items, PoVE 27.2%), uncertainty (6 items, PoVE 26.0%), and family impact (2 items, PoVE 16.3%). Older women were less likely to indicate very/somewhat worried to ≥1 item in the economic (51.4% vs 72.4%, p = 0.006), uncertainty (80.6% vs. 98.0%, p = 0.001), and family impact component (55.6% vs. 70.4%, p = 0.03). No other age differences were found. Conclusions While worry during OC treatment decision-making may differ across age groups, values do not. Research should assess how differences in worry might affect OC medical decision-making for older and younger women.

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“…6,8,15,24,26,27 Studies have demonstrated that Black populations have worse survival due to barriers to receipt of quality care, 28,29 including late diagnosis, higher comorbidity burden, 30 and less access to high-volume surgeons. 31,32 HCA is well recognized as a fundamental contributor to receipt of appropriate OC treatment, but most prior studies only evaluated one dimension or component of HCA, 31,[33][34][35] whereas this study attempts to comprehensively capture multiple dimensions of HCA. We found that patients with higher affordability were more likely to receive guideline-concordant surgery and initiate and complete chemotherapy, which is consistent with past findings that low SES is associated with lower likelihood to undergo surgery or receive chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study

Wilson

Previs

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Racial disparities exist in receipt of guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities. Methods: We analyzed data from non-Hispanic (NH)–Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of guideline-concordant OC surgery and chemotherapy was defined based on the NCCN Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA. Results: The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01–1.08) and availability (RR, 1.06; 95% CI, 1.02–1.10) were associated with receipt of guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05–1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75–0.99). Conclusions: Multiple HCA dimensions predict receipt of guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.

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Disparities in Use of Gynecologic Oncologists for Women with Ovarian Cancer in the United States

Cited by 13 publications

References 45 publications

Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival

Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival

Values and worries of ovarian cancer patients

Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study

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