Black women diagnosed with epithelial ovarian cancer have poorer survival compared to white women. Factors that contribute to this disparity, aside from socioeconomic status and guideline‐adherent treatment, have not yet been clearly identified. We examined data from the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium which harmonized data on 1074 Black women and 3263 white women with ovarian cancer from seven US studies. We selected potential mediators and confounders by examining associations between each variable with race and survival. We then conducted a sequential mediation analysis using an imputation method to estimate total, direct, and indirect effects of race on ovarian cancer survival. Black women had worse survival than white women (HR = 1.30; 95% CI 1.16‐1.47) during study follow‐up; 67.9% of Black women and 69.8% of white women died. In our final model, mediators of this disparity include college education, nulliparity, smoking status, body mass index, diabetes, diabetes/race interaction, postmenopausal hormone (PMH) therapy duration, PMH duration/race interaction, PMH duration/age interaction, histotype, and stage. These mediators explained 48.8% (SE = 12.1%) of the overall disparity; histotype/stage and PMH duration accounted for the largest fraction. In summary, nearly half of the disparity in ovarian cancer survival between Black and white women in the OCWAA consortium is explained by education, lifestyle factors, diabetes, PMH use, and tumor characteristics. Our findings suggest that several potentially modifiable factors play a role. Further research to uncover additional mediators, incorporate data on social determinants of health, and identify potential avenues of intervention to reduce this disparity is urgently needed.

No abstract

Background This pilot study explored the feasibility, acceptability, and usability of a web-based intervention for survivors of physical inactivity-related cancers through a two-arm, 12-week randomized controlled trial. Secondarily, this study tested the change in physical activity (PA) and sedentary time with intervention exposure. Methods Prior to randomization to the intervention ( n = 45) or behavior “as usual” wait-listed control ( n = 40) groups, participants completed baseline surveys and an accelerometer protocol. The intervention focused on increasing PA and decreasing sedentary time through social cognitive theory techniques. Follow-up acceptability/usability surveys (intervention group only) and accelerometers were sent after the intervention period. Information on intervention completion, adverse events, and user statistics were collected to determine feasibility. Median login time and mean acceptability/usability scores were calculated. Results Participants (mean age = 60 ± 7 years) included female ( n = 80, 94%) and male survivors of breast (82%), colon (6%), endometrial (6%), bladder (4%), and kidney (2%) cancer. Seventy-eight (91.7%) participants returned partially or fully complete post-intervention data. There were no reported injuries or safety concerns. Intervention participants logged into the website for a total of 95 min (Q1, Q3 = 11, 204). System usability scores (72 ± 3) indicated above average usability of the website. Changes in time spent active and sedentary were not statistically significantly different between groups ( p = 0.45), but within-group changes suggested intervention group participants spent more time active and less time sedentary after the intervention. Conclusion Results of this pilot study suggest its feasibility and acceptability for survivors of several inactivity-related cancers. Additional research to determine long-term efficacy is warranted. This low-cost online-only intervention has the potential to have a very broad reach. Trial Registration Clinical Trials Number: NCT03983083. Date registered: June 12th, 2019

Purpose The causes for the survival disparity among Black women with epithelial ovarian cancer (EOC) are likely multi-factorial. Here we describe the African American Cancer Epidemiology Study (AACES), the largest cohort of Black women with EOC. Methods AACES phase 2 (enrolled 2020 onward) is a multi-site, population-based study focused on overall survival (OS) of EOC. Rapid case ascertainment is used in ongoing patient recruitment in eight U.S. states, both northern and southern. Data collection is composed of a survey, biospecimens, and medical record abstraction. Results characterizing the survival experience of the phase 1 study population (enrolled 2010–2015) are presented. Results Thus far, ~ 650 patients with EOC have been enrolled in the AACES. The five-year OS of AACES participants approximates those of Black women in the Surveillance Epidemiology and End Results (SEER) registry who survive at least 10-month past diagnosis and is worse compared to white women in SEER, 49 vs. 60%, respectively. A high proportion of women in AACES have low levels of household income (45% < $25,000 annually), education (51% ≤ high school education), and insurance coverage (32% uninsured or Medicaid). Those followed annually differ from those without follow-up with higher levels of localized disease (28 vs 24%) and higher levels of optimal debulking status (73 vs 67%). Conclusion AACES is well positioned to evaluate the contribution of social determinants of health to the poor survival of Black women with EOC and advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women.

Purpose: The five-year relative survival for epithelial ovarian cancer (EOC) is worse among Black women compared with White women. The causes for this disparity are likely multi-factorial but unclear as to date, no cohort study has focused specifically on Black EOC survivors. Here we present the African-American Cancer Epidemiology Study (AACES), the largest cohort of Black women diagnosed with EOC. Methods: Phase 1 began in 2010 as a multi-site population-based case-control study focused on risk, and phase 2 began enrolling newly diagnosed EOC cases in 2020. Phase 2 builds on existing infrastructure with the goal to increase the number of EOC cases by 50% and evaluate factors affecting survival with a society-to-cell approach. Both phases use rapid case ascertainment to identify potential participants and collect extensive survey data, biospecimens, medical record abstraction, and annual follow-up.Results: Phase 1 enrolled 592 women with EOC, with a median survival of 4.8 years as of 2021. These survival rates approximate those of Black women in SEER who survive at least 10 months past diagnosis. A high proportion of the cohort was found to have relatively low levels of household income, education, and insurance coverage. Conclusions and Implications for Cancer Survivors: AACES is well-positioned to evaluate the contribution of social determinants of health to the poor survival of Black women with EOC, advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women, and serve as an example of a multi-site, epidemiologic population-based study of a rare cancer in a minority population.