High-volume ovarian cancer care: Survival impact and disparities in access for advanced-stage disease☆
Graphical abstract
Introduction
The United States accounts for approximately 10% of the world ovarian cancer burden, with an estimated 22,240 new cases being diagnosed in 2013 and 14,030 disease-related deaths [1], [2]. The National Institutes of Health, National Cancer Institute, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, and the National Comprehensive Cancer Network (NCCN) have recommended that women with suspected ovarian cancer should be afforded an evaluation and surgical intervention by a qualified gynecologic oncologist, and the Society of Surgical Oncology practice guidelines add that “…optimal treatment of this disease requires the skillful and appropriate integration of cancer surgery and chemotherapy, and is best carried out in centers in which a coordinated and experienced multidisciplinary team is available” [3], [4], [5], [6].
Inadequate access to high-volume providers for disease processes with a demonstrated positive volume–outcome relationship has contributed to widespread racial disparities in cancer care in the United States [7]. For ovarian cancer, the extent to which racial and socioeconomically based differences in access to high-volume providers contribute to disparities in treatment and survival has not been well characterized [8]. The primary objective of the current study was, therefore, to investigate the impact of socio-demographic variables, including race, payer status, and socioeconomic status (SES), on access to high-volume ovarian cancer hospitals and physicians in the most clinically challenging patient population —those with stage IIIC/IV disease. As a secondary objective, we aimed to characterize the combined impact of both hospital and physician case volume on ovarian cancer-specific survival.
Section snippets
Methods
The study design was a retrospective population-based study of invasive epithelial ovarian cancer reported to California Cancer Registry (CCR) and received exempt status by the Institutional Review Board of the University of California, Irvine (HS#2011-8317). CCR case reporting is estimated to be 99% for the entire state of California, with follow-up completion rates exceeding 95% [9]. International Classification of Disease Codes for Oncology (ICD-O) based on World Health Organization's
Population characteristics
The median age at diagnosis was 65.0 years (range = 18–104 years), and 7272 patients (61.3%) had Stage IIIC disease, while 38.7% had Stage IV disease (Table 1). White patients accounted for 71.7% of cases, followed in frequency by Hispanics (15.3%), Asian/Pacific Islanders (8.3%), and Blacks (4.7%). Private insurance was the most common payer category (47.7%), and 32.5% of patients had Medicare.
A total of 400 hospitals provided care to advanced-stage ovarian cancer patients during the 11-year study
Conclusions
Eliminating health disparities and improving the health of all socio-demographic groups have become national priorities [15], [16], [17]. For women with ovarian cancer, racial and ethnic minority populations, the economically disadvantaged, and those with safety-net insurance have worse survival outcomes and are more likely to receive less than the standard of care [18], [19]. For example, data from the National Center for Health Statistics and the National Cancer Institute indicate that from
Conflict of interest statement
No author has a conflict of interest to disclose.
Acknowledgment
Dr. Robert E. Bristow was supported in part by the Queen of Hearts Foundation.
References (40)
- et al.
Do racial/ethnic disparities exist in the utilization of high-volume surgeons for women with ovarian cancer?
Gynecol Oncol
(2008) - et al.
Ovarian cancer: patterns of surgical care across the United States
Gynecol Oncol
(2006) - et al.
Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes
Gynecol Oncol
(2009) - et al.
The National Cancer Database on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm
Gynecol Oncol
(2010) - et al.
Racial disparities in ovarian cancer surgical care: a population-based analysis
Gynecol Oncol
(2011) - et al.
Have racial disparities in ovarian cancer increased over time? An analysis of SEER data
Gynecol Oncol
(2012) - et al.
The effect of centralization of primary surgery on survival in ovarian cancer patients
Obstet Gynecol
(2003) - et al.
Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR)
Gynecol Oncol
(2007) - et al.
Global ovarian cancer health disparities
Gynecol Oncol
(2013) - et al.
Analysis of racial disparities in stage IIIC epithelial ovarian cancer care and outcomes in a tertiary gynecologic oncology referral center
Gynecol Oncol
(2011)
Does equal treatment yield equal outcomes? The impact of race on survival in epithelial ovarian cancer
Gynecol Oncol
Quality of care in advanced ovarian cancer: the importance of provider specialty
Gynecol Oncol
Cancer statistics 2013
CA Cancer J Clin
(IARC) Section of Cancer Information (9/10/2013)
National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up
Gynecol Oncol
The role of the obstetrician–gynecologist in the early detection of epithelial ovarian cancer. Committee Opinion No. 477. American College of Obstetricians and Gynecologists
Obstet Gynecol
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): ovarian cancer including fallopian tube cancer and primary peritoneal cancer. Version 2.2013
Ovarian cancer surgical practice guidelines
Oncology
What happens to racial and ethnic minorities after cancer surgery at American College of Surgeons National Surgical Quality Improvement Program hospitals?
J Am Coll Surg
Validation of self-reported cancers in the California Teachers Study
Am J Epidemiol
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This study was funded in part by the Queen of Hearts Foundation.