Poor Ovarian Cancer Survival Linked to Racial and Ethnic Barriers

Compared with White women, Black women with ovarian cancer (OC) were less likely to consult a gynecologic oncologist and receive surgery, according to a study.

The results of the cohort study were published in JAMA Network Open.

“Multiple studies have documented lower rates of guideline-concordant treatment among Black patients,” wrote the researchers. “However, equal survival among racial groups has been documented with equal receipt of treatment, suggesting that racial disparities in OC survival may be associated with differences in access to quality health care.”

Using SEER-Medicare data in combination with publicly available data sets, the researchers generated composite scores that represented affordability, availability, and accessibility, to evaluate an association between each score and key indicators of guideline health. The main outcomes were a consultation with a gynecologic oncologist for OC, and receipt of an OC-related surgery in the 2 months prior to, or 6 months after diagnosis.

The study included a total of 8987 patients with a mean (SD) age of 76.8 (7.3) years. Of the total, 612 (6.8%) were Black, 553 (6.2%) Hispanic, and 7822 (87.0%) were White patients.

Black (unadjusted odds ratio [AOR], 0.79; 95% CI, 0.62-0.91) and Hispanic (AOR, 1.8; 95% CI, 0.67-0.99) patients were less likely to consult a gynecologic oncologist compared with White patients. Additionally, Black patients were less likely to receive surgery (AOR, 0.76; 95% CI, 0.62-0.94) than White patients.

Poor health care access availability (AOR, 1.16; 95% CI, 1.09-1.24) and affordability (AOR, 1.13; 95% CI, 1.07-1.20) were each linked with gynecologic oncologist consultation, and affordability was associated with receipt of OC surgery (AOR, 1.08; 95% CI, 1.01-1.15).

Furthermore, when adjusting for availability, affordability, and accessibility, Black patients were the least likely to consult a gynecologic oncologist (AOR, 0.80; 95% CI, 0.66-0.97) and receive surgery (AOR, 0.08; 95% CI, 0.65-0.99).

The researchers acknowledge that this study had some limitations, including reliance on administrative claims data, which may have not been precise to a patient’s situation, and the number of patients seeing a gynecologic oncologist may have been underestimated.

However, the researchers believe this study provides context on issues regarding racial and ethnic barriers to diagnosing and treating ovarian cancer. The researchers advocated for multilevel strategies to increase health care access among low-income, minority women, including more generous insurance policies, as well as hospital strategies at the clinician level, such as financial navigation services and partnerships with academic centers and community centers.

Further studies should be done to continue evaluating and challenging racial and ethnic barriers to ovarian cancer care that many low-income, minority women face, they said.

“Racial disparities persisted in receipt of surgery and consultation with a gynecologic oncologist even after accounting for the health care access (HCA) scores,” wrote the researchers. “Therefore, further research on additional HCA factors also is needed to develop context-specific interventions to improve OC survival among Black patients.

Reference

Gupta A, Chen Q, Wilson LE, et al. Factor analysis of health care access with ovarian cancer surgery and gynecologic oncologist consultation. JAMA Network Open. 2023;6(2). doi:10.1001/jamanetworkopen.2022.54595