Gynecologic oncologist impact on adjuvant chemotherapy care for stage II-IV ovarian cancer patients

Weeks, Kristin; Lynch, Charles F.; West, M. Stewart; Carnahan, Ryan M.; O’Rorke, Michael; Oleson, Jacob; McDonald, Megan; Stewart, Sherri L.; Charlton, Mary E.

doi:10.1016/j.ygyno.2021.11.001

Cited by 4 publications

(2 citation statements)

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“…This finding is consistent with prior studies, which show that administration of adjuvant chemotherapy is 48% lower among rural women as well as being 63% less likely to receive surgery by a gynecologic oncologist. 15 , 27 The multiplicity of variables that have been shown to contribute to poorer survival of rural patients suggests that this patient demographic is highly complex. Future work will be needed to further identify contributory variables that may be actionable and help to improve outcomes for rural patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies which also used Iowa Cancer Registry data, conducted enhanced medical record review, which enabled analysis of provider type and receipt of treatment from a gynecologic oncologist. 14 , 15 , 27 Unfortunately, in this study, we were not able to conduct additional medical record review to assess either provider referrals to gynecologic oncologists and/or centers of excellence, the exact location of where they received their care, or whether the patients received treatment that meets standard of care.…”

Section: Discussionmentioning

confidence: 99%

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Association of Distance to Gynecologic Oncologist and Survival in a Rural Midwestern State

Ulmer

Greteman

McDonald

et al. 2022

Women's Health Reports

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Objectives: Rural ovarian cancer patients experience worse survival compared to urban patients. We assessed whether distance to gynecologic oncology specialists was associated with survival for patients in a rural state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients diagnosed between 1990 and 2018. Data were linked to the county-level 2018–2019 Area Health Resource File (number of surgeons and hospital beds per 100,000 population). Rurality was defined using 2013 Rural-Urban Continuum Codes; distance to the nearest gynecologic oncologist was calculated from the centroid of the county of residence to the centroid of the nearest county with a high volume health care center with a gynecologic oncologist. Associations with survival were assessed using multivariable Cox proportional hazards models. Results: Analyses included 1,562 ovarian cancer patients. Mean distance to gynecologic oncology was 60.8 miles, and median survival was 23 months. Unadjusted models showed increased distance from gynecologic oncology had progressively greater risk of death 30–49 miles (hazard ratio [HR] = 1.09, confidence interval [CI]: 1.04–1.15), 50–69 miles (HR = 1.19, CI: 1.07–1.32), 70+ miles (HR = 1.30, CI: 1.11–1.51). In adjusted models, association of distance to gynecologic oncology with risk of death was not significant; however, more advanced cancer stage and age, unmarried status, and higher county-level poverty were independently associated with increased risk of death. Conclusions: Above and beyond demographics and stage, distance to gynecologic oncology care was not an independent predictor of ovarian cancer survival. Further studies are needed to determine how to mitigate the factors contributing to worsened ovarian cancer survival among rural patients.

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Section: Discussionmentioning

confidence: 99%