Racial disparities and patterns of ovarian cancer surgical care in California

Abstract

Objective To investigate disparities in the frequency of ovarian cancer-related surgical procedures and access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer according to race. Methods The California Office of Statewide Health Planning and Development database was accessed for women undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 1/1/06 and 12/31/10. Multivariate logistic regression analyses were used to evaluate differences in the odds of selected surgical procedures and access to high-volume centers (hospitals≥20 cases/year) according to racial classification. Results A total of 7,933 patients were identified: White=5,095 (64.2%), Black=290 (3.7%), Hispanic/Latino=1,400 (17.7%), Asian/Pacific Islander=836 (10.5%) and other=312 (3.9%). White patients served as reference for all comparisons. All minority groups were significantly younger (Black mean age 57.7 years, Hispanic 53.2 years, Asian 54.5 years vs. 61.1 years, p <0.01). Hispanic patients had lower odds of obtaining care at a high-volume center (adjusted OR (adj. OR)=0.72, 95% CI=0.64-0.82, p<0.01) and a lower likelihood of lymphadenectomy (adj. OR=0.80, 95%CI=0.70–0.91, p<0.01), bowel resection (adj. OR=0.80, 95% CI=0.71–0.91, p<0.01), and peritoneal biopsy/omentectomy (adj. OR=0.69, 95% CI=0.58–0.82, p<0.01). Black racial classification was associated with a lower likelihood of lymphadenectomy (adj. OR=0.76, 95%CI=0.59–0.97, p=0.03). Conclusions Among women undergoing initial surgery for ovarian cancer, Hispanic patients are significantly less likely to be operated on at a high-volume center, and both Black and Hispanic patients are significantly less likely to undergo important ovarian cancer-specific surgical procedures compared to White patients.

Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer

“…[21–25] While others have described a racial disparity in primary treatment of ovarian cancer, [21,26,27] we did not see this pattern for secondary treatments, perhaps because we limited this analysis to those patients who received optimal primary therapy.…”

Racial health disparities in ovarian cancer: not just black and white

“…The existence of OC health disparities is undeniable, as per the evidence that has accumulated over last decade or so. For records, it needs to be acknowledged that it’s not just the AA women, but OC health disparities are evident in other populations as well, such as, Hispanics and Asian/Pacific Islanders [ 10 , 26 , 83 ]. What is not clearly understood is the basis of such disparities.…”

“…This results in increased risk of non-adherent care and the resulting sub-optimal treatment and follow-up. AA patients are also significantly less likely to undergo initial surgical intervention for OC at big, high-volume hospitals, compared to CA patients [ 26 ]. Participation of minorities in clinical trials is yet another challenge.…”

Inhibition of Tyrosine 3-Monooxygenase/Tryptophan 5-Monooxygenase Activation Protein Zeta (YWHAZ) Overcomes Drug Resistance and Tumorigenicity in Ovarian Cancer

“…This high mortality rate is due in part to the fact that most new cases of ovarian cancer are detected at advanced stages. Although cancer patients often initially respond to postoperative adjuvant platinum and taxane chemotherapy, most of them relapse within 12-24 months and gradually die of chemotherapeutic drug resistance [6][7][8][9]. The standard chemotherapy procedure for ovarian cancer is usually accompanied by chemical resistance, which is a major obstacle to a lasting cure [10][11][12].…”