Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis

Abstract

BackgroundOvarian cancer remains a leading cause of death from gynecological malignancies. Race, socioeconomic status (SES), and access to health care are important predictors of quality treatment and survival. We provide a systematic review and meta-analysis on the role of these predictors on disparities in ovarian cancer treatment and mortality.MethodsUsing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, EMBASE, and Scopus for relevant articles published between January 2000 and March 2017. We selected studies published in the United States that evaluated the role of race, SES, or health-care access on disparities in ovarian cancer treatment or survival. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated for each outcome using a random-effects model.ResultsA total of 41 studies met the inclusion criteria for systematic review. In meta-analysis, there was a 25% decrease (RR = 0.75, 95% CI = 0.66 to 0.84) in receipt of adherent ovarian cancer treatment and 18% increased risk (RR = 1.18, 95% CI = 1.11 to 1.26) of mortality for blacks compared to whites. Receipt of adherent ovarian cancer treatment was 15% lower (RR = 0.85, 95% CI = 0.77 to 0.94) in the lowest vs highest SES group and 30% lower (RR = 0.70, 95% CI = 0.58 to 0.85) among patients at lower vs higher hospital volumes.ConclusionWe found consistent and strong evidence for continued lack of quality ovarian cancer treatment and higher mortality among ovarian cancer patients who are black, are of low SES, and/or have poor access to care. Interventions focused on these groups targeting specific barriers to care are needed to reduce disparities in ovarian cancer treatment and mortality.

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“…TTD differed significantly by race and ethnicity once other covariables were accounted for; this has been demonstrated in other cancers 35,36 and reflects the broader racial and ethnic disparities in ovarian cancer care in the United States. 1,[37][38][39][40][41] Increased TTD for Hispanic patients is likely the result of complex social determinants of health and elements of structural racism within the US Cancer November 15, 2021 medical system leading up to diagnosis. 42 These structural problems within the medical system are especially important to address in a disease such as ovarian cancer, where adherence to guideline recommendations can mitigate survival disparities between races.…”

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“…The burden is worsened in developing countries such as India, where nearly 70% of the national population resides in rural areas and must travel to urban tertiary care centers for treatment ( 101 , 102 ). Studies have also revealed racial disparities in access to cancer treatment worldwide ( 103 , 104 ). Furthermore, inequalities between SES groups are also significant within developing countries.…”

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“…Black and Hispanic women, compared with White women, and women of lower SES were also less likely to receive radiation therapy after breast‐conservation surgery, as recommended in treatment guidelines 96 . Disparities in the receipt of treatment also exists for most other cancers, such as cancers of the colorectum, 97 pancreas, 98 uterus, 99 ovary, 100 and esophagus 101 . Increased use of precision medicine and other innovative, advanced medical technologies, which are generally associated with higher costs, may result in further widening of disparities in the receipt of guideline‐concordant cancer treatments 89,102,103,104,105,106 …”