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Association between time to diagnosis, time to treatment, and ovarian cancer survival in the United States
  1. Sarah P Huepenbecker1,
  2. Charlotte C Sun1,
  3. Shuangshuang Fu2,3,
  4. Hui Zhao2,
  5. Kristin Primm4,
  6. Jose Alejandro Rauh-Hain1,
  7. Nicole D Fleming1,
  8. Sharon H Giordano2 and
  9. Larissa A Meyer1
  1. 1 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
  4. 4 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Larissa A Meyer, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1362, Houston, Texas 77030, USA; lmeyer{at}mdanderson.org

Abstract

Objective Evaluate the association between time to diagnosis and treatment of advanced ovarian cancer with overall and ovarian cancer specific mortality using a retrospective cross sectional study of a population based cancer registry database.

Methods The Surveillance, Epidemiology, and End Results–Medicare database was searched from 1992 to 2015 for women aged ≥66 years with epithelial ovarian cancer and abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of cancer diagnosis. Time from presentation to diagnosis and treatment were evaluated as outcomes and covariables. Cox regression models and adjusted Kaplan–Meier curves evaluated 5 year overall and cancer-specific survival.

Results Among 13 872 women, better survival was associated with longer time from presentation to diagnosis (overall survival hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.94 to 0.95; cancer specific survival HR 0.95, 95% CI 0.94 to 0.96) and diagnosis to treatment (overall survival HR 0.94, 95% CI 0.92 to 0.96; cancer specific survival HR 0.93, 95% CI 0.91 to 0.96). There was longer time from presentation to diagnosis in Hispanic women (relative risk (RR) 1.21, 95% CI 1.12 to 1.32) and from diagnosis to treatment in non-Hispanic black women (RR 1.36, 95% CI 1.21 to 1.54), with lower likelihood of survival at 5 years after adjustment for time to diagnosis and treatment among non-Hispanic black women (HR 1.15, 95% CI 1.05 to 1.26) compared with non-Hispanic white women. Gynecologic oncology visit was associated with improved overall (p<0.001) and cancer specific (p<0.001) survival despite a longer time from presentation to treatment (p<0.001).

Conclusion Longer time to diagnosis and treatment were associated with improved survival, suggesting that tumor specific features are more important prognostic factors than the time interval of workup and treatment. Significant sociodemographic disparities indicate social determinants of health influencing workup and care. Gynecologic oncologist visits were associated with improved survival, highlighting the importance of appropriate referral for suspected ovarian cancer.

  • ovarian cancer

Data availability statement

Data may be obtained from a third party and are not publicly available. This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. In accordance with the policy of NCI, the authors are not able to provide SEER–Medicare data to any other individual or investigator. Investigators interested in the data should contact NCI to discuss arrangements for ordering an extra copy of the dataset.

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Data availability statement

Data may be obtained from a third party and are not publicly available. This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. In accordance with the policy of NCI, the authors are not able to provide SEER–Medicare data to any other individual or investigator. Investigators interested in the data should contact NCI to discuss arrangements for ordering an extra copy of the dataset.

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Footnotes

  • Twitter @sarah_huep, @huizhao_liu@yahoo.com, @nicoleflemingmd

  • Contributors SH: conceptualization, methodology, investigation, and writing–original draft preparation. CCS: conceptualization, methodology, writing–review and editing, and supervision. SF: methodology, software, validation, formal analysis, data curation, and writing–review and editing. HZ: methodology, validation, and writing–review and editing. KP: conceptualization and writing–review and editing. JAR-H and NDF: writing–review and editing. SHG: writing–review and editing, and supervision. LAM: conceptualization, methodology, writing–review and editing, and supervision. LAM is responsible for the overall content as guarantor.

  • Funding This work was supported in part by the MD Anderson Cancer Center support grant from the National Cancer Institute of the National Institutes of Health (NIH/NCI P30 CA016672, CA217685) and the T32 training grant CA101642. LAM is supported by a NIH-NCIK07-CA201013 grant.

  • Competing interests LAM reports consulting fees from Bristol Meyers Squibb, advisory board participation for GlaxoSmithKline, and stocks in Crisper, Invitae, and Bristol-Myers Squibb. CCS reports partial research funding from AstraZeneca and stock in Inform Genomics. JAR-H reports research funding from NIH/NCI grant K08 CA234333. NDF reports consulting fees from GlaxoSmithKline/Tesaro and Bristol-Myers-Squibb/Pfizer.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.