Racial disparities in the treatment of advanced epithelial ovarian cancer

Obstet Gynecol. 2013 Nov;122(5):1025-32. doi: 10.1097/AOG.0b013e3182a92011.

Abstract

Objective: To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer.

Methods: We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or stage IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment.

Results: Black women with advanced epithelial ovarian cancer were more likely to die than white women (unadjusted hazard ratio [HR] 1.27; 95% confidence interval [CI] 1.10-1.46). Black women were less likely than white women to receive guideline-recommended care (54% compared with 68%; P<.001), and women who did not receive recommended treatment had lower survival rates than women who received recommended care. Cox proportional hazards models demonstrated no differences in black women compared with white women regarding mortality among women who were treated with guideline-recommended care (adjusted HR 1.04; 95% CI 0.85-1.26), or among women who received incomplete treatment (adjusted HR 1.09; 95% CI 0.89-1.34). The survival analysis of patients matched by propensity score confirmed these analyses.

Conclusions: Differences in rates of treatment with guideline-recommended care are associated with black-white mortality disparities among women with advanced epithelial ovarian cancer.

Level of evidence: III.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / ethnology*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Ovarian Epithelial
  • Cohort Studies
  • Combined Modality Therapy
  • European Continental Ancestry Group / ethnology*
  • Female
  • Gynecologic Surgical Procedures
  • Healthcare Disparities / ethnology*
  • Humans
  • Medicare / statistics & numerical data
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / ethnology*
  • Neoplasms, Glandular and Epithelial / mortality
  • Neoplasms, Glandular and Epithelial / therapy*
  • Ovarian Neoplasms / ethnology*
  • Ovarian Neoplasms / mortality
  • Ovarian Neoplasms / therapy*
  • Practice Guidelines as Topic
  • Propensity Score
  • SEER Program
  • Survival Rate
  • United States / epidemiology

Substances

  • Antineoplastic Agents