The Role of Multilevel Healthcare Access Dimensions in Ovarian Cancer Disparities

Ovarian cancer survival improved dramatically in the 1980s and 1990s after the development of surgical debulking and platinum based chemotherapy treatment. However, less than 40% of women receive stage-appropriate guideline adherent surgery and chemotherapy, and Black women are even less likely to receive quality treatment. Low quality treatment is a problem for all women, and while 5-year survival for White women with ovarian cancer improved modestly from 37% to 45% between 1975 and 2006, survival declined for Black women from 43% to 37%. This disparity is likely due to differences in access to quality care, and extends to post-treatment supportive care and symptom management, resulting in Black cancer survivors having significantly higher depression, pain, and fatigue than White survivors. Our preliminary studies suggest that although Black patients have higher availability of healthcare resources, they report lower acceptability (e.g. provider trust), which impacts the receipt of quality care, quality of life and survival. In this proposal, we will utilize innovative and interdisciplinary methods integrating cancer epidemiology, health disparities and health services research, to measure all healthcare access (HCA) dimensions including availability, affordability, accessibility, accommodation and acceptability among Blacks and Whites, and evaluate the association with racial disparities in quality treatment, survival and quality of life among ovarian cancer patients. We will 1) characterize racial differences in HCA dimensions among ovarian cancer patients using data from SEER-Medicare and a population-based sample of 1,010 ovarian cancer patients, 2) evaluate the associations between HCA dimensions and receipt of quality initial treatment and supportive care by race, and 3) evaluate racial disparities in the association between HCA dimensions and patient-reported outcomes in domains that are prevalent yet manageable in cancer survivors, such as pain, depression and fatigue. This study will provide novel, empirical, generalizable and population-based data on the distinct and collective influence of HCA dimensions on ovarian cancer care and outcomes among Black and White patients and explain why disparities in quality treatment, survival and quality of life persists. Intervention strategies building on our findings will address empirically identified race-specific barriers to care, and improve the quality and length of survival for women with ovarian cancer and other chronic diseases with similarly complex treatment.