Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival

Abstract

Purpose Among ovarian cancer patients, African American (AA) women experience poorer survival compared to other race/ethnicity groups. This has been attributed to differences in access to health care. Experimental Design We evaluated racial/ethnic differences in chemotherapy dosing and survival in a cohort study among members of Kaiser Permanente Northern California, and thus with equivalent access to health care. Analyses included epithelial invasive ovarian cancer cases (n=793) receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent, with median follow-up of 50 months. Relative dose intensity (RDI) was computed for carboplatin and paclitaxel separately as dose administered/week divided by expected dose/week, and average RDI (ARDI) was then calculated for the regimen. Proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for relevant covariates. Results Compared to whites, AAs were more likely to have dose reduction (ARDI<85%), treatment delay, and early discontinuation. Hispanics were also more likely to have dose reduction, but less likely to have early discontinuation or treatment delay. After controlling for prognostic factors including ARDI, AA women had the worst survival. Compared to whites, adjusted HRs (95% CI) for overall mortality were 1.56 (1.01-2.39) for AA; 0.89 (0.61-1.31) for Asians; and 1.41 (0.98-2.04) for Hispanics. Findings for ovarian cancer-specific mortality were similar. Conclusions Disparities in ovarian cancer treatment and survival in AA persisted among women with equal access to care. These findings warrant further evaluation of biological, personal, and social factors that may be responsible for these differences.

Impact of body mass index on ovarian cancer survival varies by stage

“…Similarly, because of the known racial disparities in ovarian cancer survival, with African-American women experiencing the worse survival (Chornokur et al , 2013; Bandera et al , 2016), we explored the association of obesity with ovarian cancer survival by race/ethnicity and found no differential effects (data not shown), but these analyses had limited statistical power. Larger studies in multiethnic populations are required to further explore these associations.…”

Ovarian cancer statistics, 2018

“…For example, 5‐year cause‐specific survival for serous carcinoma is 47% to 48% in NHW, API, and Hispanic women compared with 36% in NHB women (Table ). Indeed, serous carcinoma survival is lowest among NHB women for every stage of diagnosis, likely due in part to lower receipt of guideline‐adherent treatment . Furthermore, NHBs have among the lowest stage‐specific survival across epithelial cancer subtypes.…”

“…The relatively high survival in APIs for epithelial cancers overall reflects their low incidence of serous carcinoma as well as high survival across subtypes (Table ). Reasons for this survival advantage are unknown but may include better response to treatment . Overall 5‐year cause‐specific epithelial cancer survival in NHW women has improved from 40% for cases diagnosed from 1992 to 1994 to 47% for cases diagnosed from 2007 to 2013 .…”

“…The most common sign of advanced disease is swelling of the abdomen caused by ascites . However, studies indicate that some women experience persistent, nonspecific symptoms in the months before diagnosis, including back pain, abdominal distension, pelvic or abdominal pain, difficulty eating or feeling full quickly, vomiting, indigestion, altered bowel habits, or urinary urgency or frequency . Women who experience such symptoms daily for more than a few weeks should seek prompt medical evaluation.…”

Challenges and Opportunities in Studying the Epidemiology of Ovarian Cancer Subtypes

“…African American women experience worse survival than women of European ancestry, while women of Asian ancestry tend to have better survival [61]. This could in part be due to differences in distributions of histotypes across racial/ethnic groups but is also likely impacted by disparities in access to care and treatment [62]. …”