Disparity of ovarian cancer survival between urban and rural settings

Abstract

ObjectiveTo determine if there is a difference in overall survival of patients with epithelial ovarian cancer in rural, urban, and metropolitan settings in the United States.MethodsWe performed a retrospective cohort study using 2004–2016 National Cancer Database (NCDB) data including high and low grade, stage I-IV disease. Bivariate analyses used Student’s t-test for continuous variables and χ2 test for dichotomous variables. Kaplan-Meier curves estimated survival of patients based on location of residence, and univariate analyses using Cox proportional HR assessed survival based on baseline characteristics. Multivariate analysis was performed to account for significant covariates. Propensity score matching was used to validate the multivariate survival model. For all tests, p<0.05 was considered statistically significant.ResultsA total of 111 627 patients were included with a mean age of 62.5 years for metroolitan (range 18–90), 64.0 years for rural (range 19–90) and 63.2 years for urban areas (range 18–90). Of all patients included, 94 290 were in a metropolitan area (counties >1 million population or 50 000–999 999), 15 386 were in an urban area (population of 10 000–49 999), and 1951 were in a rural area (non-metropolitan/non-core population). Univariate Cox proportional hazards models showed clinically significant differences in survival in patients from metropolitan, urban, and rural areas. Multivariate Cox proportional hazards models showed a clinically significant increase in HRs for patients in rural settings (HR 1.17; 95% CI 1.06 to 1.29). Increasing age and stage, non-insured status, non-white race, and comorbidity were also significant for poorer survival.ConclusionPatients with ovarian cancer who live in rural settings with small populations and greater distance to tertiary care centers have poorer survival. These differences hold after controlling for stage, age, and other significant risk factors related to poorer outcomes. To improve clinical outcomes, we need further studies to identify which of these factors are actionable.

The mortalities of female-specific cancers in China and other countries with distinct socioeconomic statuses: A longitudinal study

“…Obesity, resting energy expenditure, and related systemic inflammation are related to the increased mortalities of the two cancers in postmenopausal women [31] , [32] , [33] , [34] . The difference in the mortality of ovarian cancer between urban and rural areas in China is different from the situation in the USA [35] , possibly because of the differing HDI between the countries. Compared to women in urban areas, women in rural areas usually have less mood and anxiety disorders, earlier marriage, more breastfeeding, increasing body mass index (BMI), consumption of less processed meat, poorer medical insurance coverage, and lower educational level in China [15] , [28] , [36] , [37] .…”

The use of intraperitoneal chemotherapy for advanced ovarian cancer – The experience of a tertiary referral centre

“…11 Previous studies of patients in the United States have shown that cancer survival is lower for patients who live far from their referral centres. 12 Australia is a large but sparsely populated continent, so studying the outcomes of rural and regional patients is essential. We hypothesised that patients would be less likely to take up IP chemotherapy if they lived a greater distance from the hospital.…”

“…There is a well‐documented rural/metropolitan divide in patients who participate in clinical trials, with those living in a metropolitan area being more likely to participate 11 . Previous studies of patients in the United States have shown that cancer survival is lower for patients who live far from their referral centres 12 . Australia is a large but sparsely populated continent, so studying the outcomes of rural and regional patients is essential.…”

Association of Distance to Gynecologic Oncologist and Survival in a Rural Midwestern State

“…A large National Cancer Database study also demonstrated that patients with ovarian cancer who live in rural settings with small population and greater distance to tertiary care centers have poorer survival 26 ; however, the specific barriers that rural patients encounter after diagnosis that lead to worsened survival have not been fully examined. Results of this study suggest that distance to gynecologic oncology specialists does not make an independent contribution to the worsened survival that rural ovarian cancer patients experience.…”