Abstract
Background: Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. Methods: We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results–Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. Results: The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70–0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77–1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76–0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92–0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04–1.21). Conclusions: Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. Impact: Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.
| Original language | English |
|---|---|
| Pages (from-to) | 1383-1393 |
| Number of pages | 11 |
| Journal | Cancer Epidemiology Biomarkers and Prevention |
| Volume | 31 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2022 |
Bibliographical note
Publisher Copyright:©2022 American Association for Cancer Research
Funding
The authors acknowledge the helpful assistance provided by the SEER-Medicare reviewers, Information Management System coordinator Elaine Yanisko, and all the patients whose valuable data contributed to this study. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number R37CA233777 (to T.F. Akinyemiju). L.E. Wilson reports grants from National Cancer Institute during the conduct of the study; and grants from AstraZeneca outside the submitted work. M. Pisu reports grants from NIH during the conduct of the study. R.A. Previs reports other support from Myriad Genetics and Natera outside the submitted work. K.C. Ward reports other support from NCI SEER during the conduct of the study. M.J. Schymura reports grants from NCI/Duke University School of Medicine during the conduct of the study. No disclosures were reported by the other authors.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| National Childhood Cancer Registry – National Cancer Institute | R37CA233777 |
| National Childhood Cancer Registry – National Cancer Institute | |
| AstraZeneca |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
ASJC Scopus subject areas
- Epidemiology
- Oncology
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