The impact of expanding gynecologic oncology care to ovarian cancer patients in small cities and rural communities

Swayze, Emma; Strzyzewski, Lauren; Avula, Pooja; Zebolsky, Aaron L.; Hoekstra, Anna V.

doi:10.1016/j.ygyno.2021.04.021

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…30 Eight articles described interventions focused on improving cancer-related health equity. Several studies (n = 6) included a metric pertaining to receipt of standard care [31][32][33][34] or survival duration/mortality. 33,35 One study evaluated the rate of clinical trial enrollment 36 while another evaluated shared decision-making, decision regret, and quality of life.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies (n = 6) included a metric pertaining to receipt of standard care [31][32][33][34] or survival duration/mortality. 33,35 One study evaluated the rate of clinical trial enrollment 36 while another evaluated shared decision-making, decision regret, and quality of life. 37 Two articles included cancer survivors or family caregivers, using interventions focused on improving physical activity for cancer-related symptoms and quality of life 38 or telehealth support for family members in palliative care to reduce caregiver distress and increase quality of life.…”

Section: Resultsmentioning

confidence: 99%

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Cancer‐Specific health equity metrics in the United States of America: A scoping review

et al. 2023

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cancer‐Specific health equity metrics in the United States of America: A scoping review

et al. 2023

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“…More research is needed to identify the exact health system factors driving barriers to care. In addition, research on healthcare policy would be useful to help curtail rural disparities 6 8 37–40. Currently, our healthcare policies favor large populations due to, among other things: (1) Financial marketing systems that rely on large populations of insured beneficiaries in order to provide services, (2) Prioritization of outcomes on the national level, which shifts resource allocation to large population centers, and (3) No method of compensating for innate efficiencies in remote healthcare settings 6.…”

Section: Discussionmentioning

confidence: 99%

Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study

Taylor

Gangnon

Powell

et al. 2023

BMJ Open Diab Res Care

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IntroductionRural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion.Research design and methodsThis 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013–2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black.ResultsOverall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black.ConclusionsA smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.

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“… 14 , 15 A recent study demonstrated that a gynecologic oncology practice started in a small city with surrounding rural communities significantly reduced travel distance from 48 to 27 miles, improved the percent of people receiving surgery from a gynecologic oncologist from 53% to 97%, and increased median survival time from 31 to 53 months. 36 …”

Section: Discussionmentioning

confidence: 99%

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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The impact of expanding gynecologic oncology care to ovarian cancer patients in small cities and rural communities

Cited by 4 publications

References 23 publications

Cancer‐Specific health equity metrics in the United States of America: A scoping review

Cancer‐Specific health equity metrics in the United States of America: A scoping review

Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study

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

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