Socioeconomic differences impact overall survival in advanced ovarian cancer (AOC) prior to achievement of standard therapy

Phillips, Andrew; Kehoe, Sean; Singh, Kavita; Elattar, Ahmed; Nevin, James; Balega, Janos; Pounds, Rachel; El-Modir, Ahmed; Pascoe, Jennifer; Fernando, Indrajit; Sundar, Sudha

doi:10.1007/s00404-019-05269-8

Cited by 8 publications

(16 citation statements)

References 33 publications

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“…, death from any cause). 6 - 8 , 11 , 14 , 16 , 17 , 20 - 26 , 33 , 37 - 39 , 41 , 42 , 45 , 46 , 48 , 50 , 51 , 53 , 55 - 58 , 62 , 63 , 70 , 72 , 78 , 79 Other studies reported both overall and cancer-specific or relative/net survival. 9 , 12 , 15 , 29 , 31 , 40 , 43 , 47 , 54 , 59 , 64 , 65 , 67 - 69 …”

Section: Resultsmentioning

confidence: 99%

“…Of the 4 studies that assessed ovarian cancer, studies from France and the US found that the observed gap in overall survival was partly explained by variations in stage at diagnosis and the treatment received. 42 , 45 A Danish study reported differential stage at diagnosis, tumor histological type, co-morbidities and health-related lifestyle behaviors as some of the explanatory factors. 23 In contrast, a study from Norway found that stage of ovarian cancer or smoking status prior to diagnosis did not contribute to overall survival gap between education groups.…”

Section: Resultsmentioning

confidence: 99%

“…All studies, except 3, had a low risk for the domain of bias due to selective reporting of results. 41 , 43 , 47 With respect to missing data, we assigned moderate risk of bias to twenty-three studies that had 10-20% of their data missing, 7 , 13 , 20 , 25 - 27 , 30 , 34 , 37 , 38 , 40 , 42 , 44 , 45 , 53 , 54 , 57 , 58 , 61 , 64 , 67 , 69 , 78 and high risk to eleven studies with more than 20% missing data, 33 , 39 , 41 , 43 , 46 , 48 , 65 , 66 , 72 , 75 , 79 regardless of whether multiple imputation was applied.…”

Section: Resultsmentioning

confidence: 99%

“…data missing, 7,13,20,[25][26][27]30,34,37,38,40,42,44,45,53,54,57,58,61,64,67,69,78 and high risk to eleven studies with more than 20% missing data, 33,39,41,43,46,48,65,66,72,75,79 regardless of whether multiple imputation was applied.…”

Section: Discussionmentioning

confidence: 99%

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Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

2021

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Background: There is strong and well-documented evidence that socio-economic inequality in cancer survival exists within and between countries, but the underlying causes of these differences are not well understood. Methods: We systematically searched the Ovid Medline, EMBASE, and CINAHL databases up to 31 May 2020. Observational studies exploring pathways by which socio-economic position (SEP) might causally influence cancer survival were included. Results: We found 74 eligible articles published between 2005 and 2020. Cancer stage, other tumor characteristics, health-related lifestyle behaviors, co-morbidities and treatment were reported as key contributing factors, although the potential mediating effect of these factors varied across cancer sites. For common cancers such as breast and prostate cancer, stage of disease was generally cited as the primary explanatory factor, while co-morbid conditions and treatment were also reported to contribute to lower survival for more disadvantaged cases. In contrast, for colorectal cancer, most studies found that stage did not explain the observed differences in survival by SEP. For lung cancer, inequalities in survival appear to be partly explained by receipt of treatment and co-morbidities. Conclusions: Most studies compared regression models with and without adjusting for potential mediators; this method has several limitations in the presence of multiple mediators that could result in biased estimates of mediating effects and invalid conclusions. It is therefore essential that future studies apply modern methods of causal mediation analysis to accurately estimate the contribution of potential explanatory factors for these inequalities, which may translate into effective interventions to improve survival for disadvantaged cancer patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

2021

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“… 11 , 12 , 13 Lower SES has also been specifically associated with reduced likelihood of receiving OC surgery. 23 , 24 Although research looking at factors associated with gynecologic oncologist consultation is limited, our observed association with affordability is reasonable, as specialist care is known to be cost-prohibitive for some patients, particularly for those who do not have robust insurance coverage. 25 , 26 These individuals may delay or avoid seeking care due to cost, leading to worsened conditions and poorer survival.…”

Section: Discussionmentioning

confidence: 83%

Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation

et al. 2023

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ImportancePoor health care access (HCA) is associated with racial and ethnic disparities in ovarian cancer (OC) survival.ObjectiveTo generate composite scores representing health care affordability, availability, and accessibility via factor analysis and to evaluate the association between each score and key indicators of guideline-adherent care.Design, Setting, and ParticipantsThis retrospective cohort study used data from patients with OC diagnosed between 2008 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The SEER Medicare database uses cancer registry data and linked Medicare claims from 12 US states. Included patients were Hispanic, non-Hispanic Black, and non-Hispanic White individuals aged 65 years or older diagnosed from 2008 to 2015 with first or second primary OC of any histologic type (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3] code C569). Data were analyzed from June 2020 to June 2022.ExposuresThe SEER-Medicare data set was linked with publicly available data sets to obtain 35 variables representing health care affordability, availability, and accessibility. A composite score was created for each dimension using confirmatory factor analysis followed by a promax (oblique) rotation on multiple component variables.Main Outcomes and MeasuresThe main outcomes were consultation with a gynecologic oncologist for OC and receipt of OC-related surgery in the 2 months prior to or 6 months after diagnosis.ResultsThe cohort included 8987 patients, with a mean (SD) age of 76.8 (7.3) years and 612 Black patients (6.8%), 553 Hispanic patients (6.2%), and 7822 White patients (87.0%). Black patients (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) and Hispanic patients (aOR, 0.81; 95% CI, 0.67-0.99) were less likely to consult a gynecologic oncologist compared with White patients, and Black patients were less likely to receive surgery after adjusting for demographic and clinical characteristics (aOR, 0.76; 95% CI, 0.62-0.94). HCA availability and affordability were each associated with gynecologic oncologist consultation (availability: aOR, 1.16; 95% CI, 1.09-1.24; affordability: aOR, 1.13; 95% CI, 1.07-1.20), while affordability was associated with receipt of OC surgery (aOR, 1.08; 95% CI, 1.01-1.15). In models mutually adjusted for availability, affordability, and accessibility, Black patients remained less likely to consult a gynecologic oncologist (aOR, 0.80; 95% CI, 0.66-0.97) and receive surgery (aOR, 0.80; 95% CI, 0.65-0.99).Conclusions and RelevanceIn this cohort study of Hispanic, non-Hispanic Black, and non-Hispanic White patients with OC, HCA affordability and availability were significantly associated with receiving surgery and consulting a gynecologic oncologist. However, these dimensions did not fully explain racial and ethnic disparities.

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Molecular Oncology of Gynecologic Tumors

Alvarado‐Cabrero

2020

Archives of Medical Research

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Socioeconomic differences impact overall survival in advanced ovarian cancer (AOC) prior to achievement of standard therapy

Cited by 8 publications

References 33 publications

Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation

Molecular Oncology of Gynecologic Tumors

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