Minority Patients With Gynecologic Cancers More Likely to Receive Treatment at Academic Facilities

Compared with White patients, minority patients with gynecologic cancers had higher odds of receiving treatment at academic facilities, according to a study published in Gynecologic Oncology.¹

The researchers noted that there are persistent racial and ethnic disparities throughout the gynecologic cancer care delivery pathway. For example, minority women are more likely to have poorer follow-up after an abnormal cervical screening, experience lower rates and delays in ovarian cancer genetic testing, and enroll in clinical trials less often.^2-4

Gynecologic cancer treatment also often requires collaboration between multiple specialists in various settings.¹ Because of this, the researchers hypothesized that the type of facility where patients receive care could contribute to treatment and survival disparities.

Therefore, they conducted a study to analyze the association of the race and ethnicity of patients with treatment facility types. To do so, they characterized where patients with gynecologic cancer typically receive treatment and examined how the relationship between race, ethnicity, and facility type impacts overall survival.

Minority patients with gynecologic cancers are more likely than White patients to receive treatment at academic facilities, highlighting persistent racial and ethnic disparities in cancer care. | Image Credit: Stafeeva - stock.adobe.com

To create their study population, the researchers used the 2021 Participant User File from the National Cancer Database (NCDB), which captures 70% of cancers diagnosed in the US, to identify female patients aged 40 or older diagnosed with ovarian, cervical, uterine, fallopian tube, and peritoneal cancers between 2004 and 2020; this resulted in an initial sample of 1,107,479 patients.⁵ They obtained various data from patient medical records, including sociodemographic characteristics, treatment facility attributes, and survival outcomes.¹

The NCDB uses the Commission of Cancer Accreditation program to categorize facilities into 4 categories: Community Cancer Programs, Comprehensive Community Cancer Programs, Integrated Network Cancer Programs, and Academic/Research Programs. For this study, the researchers combined Community Cancer Programs, Comprehensive Community Cancer Programs, and Integrated Network Cancer Programs to represent non-academic facilities, and they considered Academic/Research Programs to be academic facilities.

The researchers excluded patients from the initial study population for various reasons, including being treated at multiple facilities and not having data on race. Consequently, the final study population consisted of 484,455 patients, 23.9% of whom were non-White.

The study population had a mean (SD) age at diagnosis of 62.9 (11.6) years. However, patients from minority groups were more likely to be diagnosed at a younger age (mean range, 56.9-62.8 vs 63.6), have Medicaid insurance (mean range, 13.9%-22.3% vs 5.3%), and live in zip codes with higher high school noncompletion rates (mean range, 19.7%-52.7% vs 13.8%).

Within the total sample, 42.7% received treatment at an academic facility. When adjusting for patient, tumor, treatment, and geographic location characteristics, the researchers found that American Indian/Alaska Native (OR, 1.64; 95% CI, 1.28-1.57), Asian (OR, 1.64; 95% CI, 1.59-1.70), Black (OR, 1.69;95% CI, 1.65-1.72), Hispanic (OR, 1.70; 95% CI, 1.66-1.75), Native Hawaiian/Pacific Islander (OR, 1.74; 95% CI, 1.57-1.93), and other race (OR, 1.29; 95% CI, 1.20-1.40) patients had higher odds of being treated at an academic facility than White patients.

Factors associated with lower odds of being treated at an academic facility included having insurance (any type, ORs range, 0.53-0.80), older age (OR per 5 years, 0.979; 95% CI, 0.975-0.982), and higher area-level education (Q4 vs Q1: OR, 0.75; 95% CI, 0.74-0.77).

Additionally, compared with White patients treated at academic facilities, the researchers observed improved overall survival among Asian patients treated at academic (HR, 0.76; 95% CI, 0.73-0.79) and non-academic (HR, 0.81; 95% CI, 0.77-0.84) facilities, Hispanic patients treated at academic (HR, 0.75; 95% CI, 0.73-0.78) and non-academic (HR, 0.84; 95% CI, 0.82-0.87) facilities, and other race patients treated at academic (HR, 0.76; 95% CI, 0.69-0.84) and non-academic (HR, 0.90; 95% CI, 0.81-0.99) facilities.

Conversely, they observed worse overall survival among Black patients treated at academic (HR, 1.10; 95% CI, 1.07-1.12) or non-academic (HR, 1.19; 95% CI, 1.16-1.21) facilities. Similarly, compared to those treated at academic facilities, White patients treated at non-academic facilities had slightly worse overall survival. Lastly, the researchers found that American Indian/Alaska Native and Native Hawaiian/Pacific Islander patients treated at either academic or non-academic facilities did not have significantly different overall survival rates.

The researchers acknowledged their limitations, one being that the NCDB does not conduct active follow-up besides survival information; they potentially misclassified factors collected at diagnosis that may change during active treatment. Despite their limitations, the researchers suggested areas for further research based on their findings.

“Future research should work towards identifying the specific aspects that confer improved survival in academic facilities, while also attempting to disseminate these aspects to the broad health care community,” the authors concluded.

References

1. Meade CE, Sinnott JA, Backes FJ, et al. Associations between race and ethnicity and treatment setting among gynecologic cancer patients. Gynecol Oncol. Published online June 28, 2024. doi:10.1016/j.ygyno.2024.06.018
2. Downs LS, Smith JS, Scarinci I, Flowers L, Parham G. The disparity of cervical cancer in diverse populations. Gynecol Oncol. 2008;109(2 Suppl):S22-S30. doi:10.1016/j.ygyno.2008.01.003
3. Chapman-Davis E, Zhou ZN, Fields JC, et al. Racial and ethnic disparities in genetic testing at a hereditary breast and ovarian cancer center. J Gen Intern Med. 2021;36(1):35-42. doi:10.1007/s11606-020-06064-x
4. Khadraoui W, Meade CE, Backes FJ, Felix AS. Racial and ethnic disparities in clinical trial enrollment among women with gynecologic cancer. JAMA Netw Open. 2023;6(12):e2346494. doi:10.1001/jamanetworkopen.2023.46494
5. Merkow RP, Rademaker AW, Bilimoria KY. Practical guide to surgical data sets: National Cancer Database (NCDB). JAMA Surg. 2018;153(9):850–851. doi:10.1001/jamasurg.2018.0492