Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996–2014

Villanueva, Carolina; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E.; Vieira, Verónica M.

doi:10.1016/j.canep.2020.101825

Cited by 8 publications

(10 citation statements)

References 55 publications

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“…4 Numerous evidence-based practices are demonstrated to improve cancer outcomes, but many are underutilized among rural cancer providers. [1][2][3]5,6 Although geographic disparities in use of evidencebased practice are widely documented, less is known about why evidence-based cancer care practices are less likely to be adopted in rural care settings or how best to increase their uptake. Some individual physician characteristics known to differ between urban and rural physicians, such as years in practice, gender, and specialty, are associated with adoption of evidence-based practice.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous evidence‐based practices are demonstrated to improve cancer outcomes, but many are underutilized among rural cancer providers 1–3,5,6 . Although geographic disparities in use of evidence‐based practice are widely documented, less is known about why evidence‐based cancer care practices are less likely to be adopted in rural care settings or how best to increase their uptake.…”

Section: Introductionmentioning

confidence: 99%

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Geographic differences in community oncology provider and practice location characteristics in the central United States

Ellis

Thompson

Boyd

et al. 2022

The Journal of Rural Health

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Purpose How care delivery influences urban‐rural disparities in cancer outcomes is unclear. We sought to understand community oncologists’ practice settings to inform cancer care delivery interventions. Methods We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal‐Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists. Findings We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural‐only, urban‐only, and urban‐rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists. Conclusions We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation‐isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban‐rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Geographic differences in community oncology provider and practice location characteristics in the central United States

Ellis

Thompson

Boyd

et al. 2022

The Journal of Rural Health

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“…The survival rate is related to the stage of the disease at the diagnosis. In patients diagnosed with advanced stage III-IV ovarian cancer, the 5-year survival rate is about 30%, whereas in those diagnosed at an early stage the 5-year survival rate is about 90% [15][16][17] . Therefore, it seems worthwhile to diagnose ovarian cancer at an early stage [18] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Calculated Risk of Malignancy Index as a Predictor of the Nature of Adnexal Masses

Mostafa

Assem

Ibrahim

2022

International Journal of Medical Arts

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Article informationBackground: Adnexal masses are common presentation among gynecological practice. Differentiation of benign than malignant lesions is of utmost importance for treatment plan. The gold standard other than histopathology did not determined yet. The aim of the work: The current work aimed to measure the predictive power of the preoperative risk of malignancy index [RMI] to discriminate between benign and malignant adnexal masses. Patients and Methods: This study included 80 patients, presented with adnexal masses/ovarian cysts. They were managed by surgery, during the period from May 2015 to November 2017. We collected the following data: age, gravidity, menopause status, parity, cancer antigen 125 [CA125] levels and ultrasound results. RMI was calculated according to Tingulstad" model. Postoperatively, histopathology results were documented for every patient and used as the gold standard diagnostic modality to measure predictive power of RMI and CA125. Results: Malignant lesions were documented in 27.5%, while 72.5% were benign. The benign tumors were significantly associated with younger age than malignant lesions [27.88±7.68 versus 41.05±11.81]. The postmenopausal women percentages were significantly higher among malignant than benign ovarian lesions [45.5% vs. 1.7%, respectively, p < 0.001]. All ultrasound parameters of RMI were significantly different in malignant than benign masses. The optimal cutoff points of RMI and CA125 were 90.6 and 20.0 respectively. At such points, RMI had 90.6 sensitivity. However, specificity, positive predictive value, negative predictive values were 68.2%, 75.9%, 51.7% and 86.3%, respectively. Conclusion: RMI represented a significant indicator in preoperative assessment of adnexal mass, and was valuable to refer patients to oncology centers, and recommended for screening purposes.

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“…Location can directly affect women’s access to care by the availability of services ( 21 , 22 ), proximity to services ( 23-26 ), transportation barriers ( 27-29 ), and local differences in cost of care or insurance coverage ( 30 ). In California, women’s location at time of diagnosis (1996-2014) statistically significantly influenced their likelihood of getting National Comprehensive Cancer Network (NCCN) guideline–adherent treatment after an OC diagnosis ( 23 , 25 ) and was an independent predictor of survival ( 24 , 26 ). Insurance status is consistently correlated with OC outcomes and often remains a determinant of receiving adequate care and disease-specific survival despite controlling for other factors ( 25 , 26 ).…”

mentioning

confidence: 99%

“…In California, women’s location at time of diagnosis (1996-2014) statistically significantly influenced their likelihood of getting National Comprehensive Cancer Network (NCCN) guideline–adherent treatment after an OC diagnosis ( 23 , 25 ) and was an independent predictor of survival ( 24 , 26 ). Insurance status is consistently correlated with OC outcomes and often remains a determinant of receiving adequate care and disease-specific survival despite controlling for other factors ( 25 , 26 ). In this population, rates of uninsured women with OC started declining in 2013.…”

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confidence: 99%

Spatial-Temporal Trends in Ovarian Cancer Outcomes in California

Villanueva

Chang

Ziogas

et al. 2022

JNCI Cancer Spectrum

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Background Research suggests that geographic location may impact ovarian cancer (OC) outcomes. Insurance status often remains an important predictor of outcomes. The Affordable Care Act was enacted in 2010 to expand access to affordable health insurance. Our objective was to examine spatiotemporal trends in OC treatment non-adherence and disease-specific mortality in California (USA) among women diagnosed with OC. Methods Newly diagnosed epithelial OC cases between 1996-2017 were identified from the California Cancer Registry. Spatiotemporal trends in adherence to treatment guidelines were examined using generalized additive models and OC-specific mortality using Cox proportional hazards additive models. Prediction grids covering California were used to display the odds ratios (ORs) and hazards ratios (HRs) of location, using the median value for the study area as the referent value. Seven overlapping 5-year time periods and two larger ones (pre- and post-2013) were assessed. Analyses were stratified according to stage (early versus advanced), and used P = 0.05 to determine statistical significance. Results Statistically significant spatial patterns in treatment non-adherence were observed for every time period examined (P < 0.001). Odds of treatment non-adherence associated with geographic location were highest among women with early-stage OC in southern Los Angeles County during 2014-2017 (OR max : 3.89, Confidence Interval: 1.04-7.61). For women with advanced-stage OC, residing in Northern California was generally associated with lower ORs, while Southern California was associated with higher ORs, with higher odds in the latter time period (OR range 0.53-1.84 in 1996-2012 vs 0.49-2.37 in 2013-2017). Geographic location was not a significant predictor of mortality. Conclusions Residential location was significantly associated with treatment received in California, with spatial patterns varying over time, but not OC-specific mortality. Changes in insurance status over time were accompanied by shifts in population demographics and increased travel distances to receive care.

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Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996–2014

Cited by 8 publications

References 55 publications

Geographic differences in community oncology provider and practice location characteristics in the central United States

Geographic differences in community oncology provider and practice location characteristics in the central United States

Evaluation of the Calculated Risk of Malignancy Index as a Predictor of the Nature of Adnexal Masses

Spatial-Temporal Trends in Ovarian Cancer Outcomes in California

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