Effect of gynecologic oncologist availability on ovarian cancer mortality

Stewart, Sherri L.; Cooney, Darryl; Hirsch, Shawn; Westervelt, Lauren; Richards, Thomas B.; Rim, Sun Hee; Thomas, Cheryll C.

doi:10.5317/wjog.v3.i2.71

Cited by 32 publications

(30 citation statements)

References 21 publications

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“…63,64 Among children, long travel times to a treatment center is associated with significant negative financial and social impacts on patients and families. 31 Our results suggest that, among adolescents, socioeconomic factors, such as poverty and health insurance coverage, may have a greater impact on cancer mortality than geographic distance to treatment facility.…”

Section: Discussionmentioning

confidence: 99%

Geographic Access to Cancer Care and Mortality Among Adolescents

Tai

Hallisey

Peipins

et al. 2018

Journal of Adolescent and Young Adult Oncology

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Purpose: Adolescents with cancer have had less improvement in survival than other populations in the United States. This may be due, in part, to adolescents not receiving treatment at Children’s Oncology Group (COG) institutions, which have been shown to increase survival for some cancers. The objective of this ecologic study was to examine geographic distance to COG institutions and adolescent cancer mortality. Methods: We calculated cancer mortality among adolescents and sociodemographic and healthcare access factors in four geographic zones at selected distances surrounding COG facilities: Zone A (area within 10 miles of any COG institution), Zones B and C (concentric rings with distances from a COG institution of >10–25 miles and >25–50 miles, respectively), and Zone D (area outside of 50 miles). Results: The adolescent cancer death rate was highest in Zone A at 3.21 deaths/100,000, followed by Zone B at 3.05 deaths/100,000, Zone C at 2.94 deaths/100,000, and Zone D at 2.88 deaths/100,000. The United States-wide death rate for whites without Hispanic ethnicity, blacks without Hispanic ethnicity, and persons with Hispanic ethnicity was 2.96 deaths/100,000, 3.10 deaths/100,000, and 3.26 deaths/100,000, respectively. Zone A had high levels of poverty (15%), no health insurance coverage (16%), and no vehicle access (16%). Conclusions: Geographic access to COG institutions, as measured by distance alone, played no evident role in death rate differences across zones. Among adolescents, socioeconomic factors, such as poverty and health insurance coverage, may have a greater impact on cancer mortality than geographic distance to COG institution.

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Section: Discussionmentioning

confidence: 99%

Geographic Access to Cancer Care and Mortality Among Adolescents

Tai

Hallisey

Peipins

et al. 2018

Journal of Adolescent and Young Adult Oncology

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“…While this may be the case, geographic disparities in ovarian cancer care have been well documented, 6,11–13 and these are likely to remain an issue for some ovarian cancer patients. A recent study in one urban National Cancer Institute-designated cancer center showed that the farther gynecologic cancer patients were required to travel to get to treatment (those traveling above 10, but less than 50 miles), the less likely they were to complete recommended care.…”

Section: Discussionmentioning

confidence: 99%

“…3–5 However, there is variable uptake of this recommendation, which may be due in part to the uneven distribution of these subspecialists across the United States and general lack of availability in rural areas where many ovarian cancer patients reside 3,6 or lack of physician referral. 7 …”

Section: Introductionmentioning

confidence: 99%

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

Stewart

Townsend

Puckett

et al. 2016

Journal of Women's Health

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Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality.

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“…Rural ovarian cancer patients have been shown to have less access to specialty surgical care and treatment once they are diagnosed with cancer. 4,[14][15][16][17][18][19] Additionally, they may have less access to diagnosing physicians. Undiagnosed women with ovarian cancer often need the skills of a perceptive primary care physician to discriminate their symptoms, which can be nonspecific and present months to years before a patient is diagnosed.…”

Section: Introductionmentioning

confidence: 99%

Impact of Rurality on Stage IV Ovarian Cancer at Diagnosis: A Midwest Cancer Registry Cohort Study

Weeks

Lynch

West

et al. 2020

The Journal of Rural Health

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Purpose We aim to understand if rurality impacts patients’ odds of presenting with stage IV ovarian cancer at diagnosis independent of distance to primary care provider and the socioeconomic status of a patient's residential census tract. Methods A cohort of 1,000 women with ovarian cancer in Iowa, Kansas, and Missouri were sampled and analyzed from the cancer registries’ statewide population data. The sample contained those with a histologically confirmed primary ovarian cancer diagnosis in 2011‐2012. All variables were captured through an extension of standard registry protocol using standardized definitions and abstraction manuals. Chi‐square tests and a multivariable logistic regression model were used. Findings At diagnosis, 111 women in our sample had stage IV cancer and 889 had stage I‐III. Compared to patients with stage I‐III cancer, patients with stage IV disease had a higher average age, more comorbidities, and were more often living in rural areas. Multivariate analysis showed that rural women (vs metropolitan) had a greater odds of having stage IV ovarian cancer at diagnosis (odds ratio = 2.41 and 95% confidence interval = 1.33‐4.39). Conclusion Rural ovarian cancer patients have greater odds of having stage IV cancer at diagnosis in Midwestern states independent of the distance they lived from their primary care physician and the socioeconomic status of their residential census tract. Rural women's greater odds of stage IV cancer at diagnosis could affect treatment options and mortality. Further investigation is needed into reasons for these findings.

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Effect of gynecologic oncologist availability on ovarian cancer mortality

Cited by 32 publications

References 21 publications

Geographic Access to Cancer Care and Mortality Among Adolescents

Geographic Access to Cancer Care and Mortality Among Adolescents

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

Impact of Rurality on Stage IV Ovarian Cancer at Diagnosis: A Midwest Cancer Registry Cohort Study

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