Objectives To assess the relationship between race, receipt of National Comprehensive Cancer Network guideline adherent care (AC), and overall survival in a population of White and Black ovarian cancer (OC) patients in the United States.

Methods We used data for ovarian cancer patients diagnosed 2011–2019 in Flatiron Health, a longitudinal database spanning > 265 cancer clinics and > 2M US patients. We defined AC as surgery and ≥6 cycles of platinum/taxane doublet chemotherapy, with variation based on NCCN guidelines in effect at diagnosis. We modeled overall survival as a function of AC, race, and clinical and demographic factors using Cox regression.

Results of 2,138 patients (median: 67 years; range 20–84), 1974 (92%) were White and 164 (8%) were Black. Only 45.3% and 45.7% of White and Black patients received AC. In multivariate analysis, AC in the overall population (HR 0.557, p<0.001) was associated with improved survival, while age (HR 1.028, p<0.001), stage IV at diagnosis (HR 1.471, p<0.001), and living in the Southern/Midwestern US (HR 1.366 and 1.342, respectively, p=0.002 and p=0.013) were associated with worsened survival. AC predicted improved survival for White patients (HR 0.540, p<0.001) but not for Black patients (HR 0.819, p=0.369).

Conclusions Adherent care (AC) predicted improved survival for White patients with OC, but not their Black counterparts. It is unclear whether differences result from the small number of Black patients in our sample, or from racial differences in the individual components of AC.The relationship between race, AC, and survival should be further investigated.