Racial Disparities in the Treatment of Advanced Epithelial Ovarian Cancer

Abstract

OBJECTIVE To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer. METHODS We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment. RESULTS Black women with advanced epithelial ovarian cancer were more likely to die than white women; unadjusted hazard ratio (HR):1.27 (95% confidence interval [CI]: 1.10-1.46). Black women were less likely than white women to receive guideline-recommended care (54% vs. 68%, p<0.001) and women who did not receive recommended treatment had lower survival than women who received recommended care. Cox proportional hazards models demonstrated no black versus white differences in mortality among women who were treated with guideline-recommended care; adjusted HR:1.04 (95% CI: 0.85-1.26) or among women who received incomplete treatment; adjusted HR:1.09 (95% CI: 0.89-1.34). The survival analysis of patients matched by propensity score confirmed these analyses. Conclusions Differences in rates of treatment with guideline-recommended care are associated with black–white mortality disparities among women with advanced epithelial ovarian cancer.

Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer

“…Despite standardized treatment guidelines, socio-demographic disparities in ovarian cancer survival have been well documented [3][4][5]. Lower survival rates have been associated with low socioeconomic status (SES), Black race, publicly funded insurance, and lack of insurance [4].…”

Racial Disparity in 30-Day Morbidity and Mortality After Surgery for Ovarian Cancer

“…In OC, improved short-and long-term outcomes as well as improved compliance with recommended treatment guidelines have repeatedly been associated with high-volume, quality-driven, tertiary care facilities; furthermore, treatment at these facilities has been demonstrated to result in an amelioration of racial disparities observed with regards to outcomes and survival. 3,6,7,9 In this study, AA patients were more likely to have preoperative comorbidities compared with W patients, specifically higher body mass index, diabetes, hypertension requiring medications, serum creatinine level greater than or equal 2, hypoalbuminemia, and anemia. Some of these preoperative comorbidities were significantly associated with adverse postoperative morbidity and mortality in multivariate analysis such as hypoalbuminemia and anemia.…”

“…3Y5 Treatment adherence to the National Comprehensive Cancer Network guidelines results in improved survival outcomes. 3,6 Although treatment at highvolume centers by high-volume providers is associated with both guidelines compliance and better survival, race and socioeconomic status have been associated with an increased likelihood of treatment at a low-volume center by a lowvolume provider. 6,7 Both the existence of disparate shortterm perioperative outcomes and their impact on racial disparities observed with regards to survival outcomes are important additional pieces of the picture that have not been thoroughly explored.…”

The Association Between Body Mass Index and Presenting Symptoms in African American Women with Ovarian Cancer

“…Understanding symptom presentation in this population is particularly important because obesity is more prevalent in African Americans, and African American women are more likely to be diagnosed with ovarian cancer at a later stage. 19,20 We hypothesized that obese women would be less likely to present with abdominal symptoms, such as distended or hard abdomen, lump in the abdomen, pelvic or abdominal discomfort, and weight gain. This was based on the notion that excess centripetal adipose tissue and increased comorbidities may interfere with an ability to appreciate such subtle and nonspecific complaints as stemming from a cause other than a benign or previously diagnosed health condition.…”