Abstract
Objective: Ovarian cancer has poor 5-year survival, particularly among non-Hispanic (NH) Black patients. Efforts to identify patients at high-risk of functional limitations and frailty may improve outcomes. In this study, we examined how healthcare access (HCA) and race/ethnicity relate to frailty among patients with ovarian cancer. Methods: We identified Hispanic, NH Black, and NH White patients diagnosed at ages ≥6 5 years with ovarian cancer between 2009 and 2015 using SEER-Medicare. Log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between HCA and race/ethnicity with pre- or post-diagnosis frailty, adjusting for age and comorbidities. Results: A total of 6041 patients with ovarian cancer were included, including 91.8% NH White, 6.6% NH Black, and 1.7% Hispanic. Pre-diagnosis, 14.7% of patients were defined as frail (NH White: 14.3%; NH Black: 17.9%; Hispanic: 20.8%). Post-diagnosis, frailty prevalence increased to 58.8% (NH White: 58.2%; NH Black: 65.2%; Hispanic: 70.2%). No statistically significant associations were observed between race/ethnicity and pre- or post-diagnosis frailty in fully adjusted models. After adjustment for patient characteristics and healthcare accessibility and availability, higher healthcare affordability was associated with a decreased prevalence of pre-diagnosis frailty (PR: 0.91, 95% CI: 0.8 5, 0.98). Conclusions: Patients with ovarian cancer have a high prevalence of frailty after diagnosis, particularly NH Black and Hispanic patients. Improving healthcare affordability may prevent or help manage frailty in Medicare patients, improve receipt of cancer treatment, and increase cancer survival.
| Original language | English |
|---|---|
| Pages (from-to) | 146-152 |
| Number of pages | 7 |
| Journal | Gynecologic Oncology |
| Volume | 190 |
| DOIs | |
| State | Published - Nov 2024 |
Bibliographical note
Publisher Copyright:© 2024 Elsevier Inc.
Funding
This research was funded by the National Institutes of Health/National Cancer Institute (Grant number R37CA233777; PI: Dr. Tomi Akinyemiju).The authors acknowledge the helpful assistance provided by the SEER-Medicare reviewers, Information Management System coordinator, and all patients whose valuable data contributed to this study. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 10388 5; Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The authors acknowledge the helpful assistance provided by the SEER-Medicare reviewers, Information Management System coordinator, and all patients whose valuable data contributed to this study. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 10388 5; Centers for Disease Control and Prevention 's (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156 ; the National Cancer Institute 's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco , contract HHSN261201800015I awarded to the University of Southern California , and contract HHSN261201800009I awarded to the Public Health Institute . The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. This research was funded by the National Institutes of Health/National Cancer Institute (Grant number R37CA233777 ; PI: Dr. Tomi Akinyemiju).
| Funders | Funder number |
|---|---|
| University of Southern California | |
| National Cancer Institute's Surveillance, Epidemiology and End Results Program | |
| Massachusetts Department for Public Health | |
| National Institutes of Health (NIH) | |
| National Cancer Institute Surveillance Epidemiology and End Results Program | |
| National Childhood Cancer Registry – National Cancer Institute | R37CA233777 |
| Centers for Disease Control and Prevention | 1NU58DP007156 |
Keywords
- Frailty
- Healthcare access
- Ovarian cancer
- Racial disparities
ASJC Scopus subject areas
- Oncology
- Obstetrics and Gynecology
