Rural residence is related to shorter survival in epithelial ovarian cancer patients

Lutgendorf, Susan K.; Ramírez, Edgardo; Schrepf, Andrew; Valentine, Mark C.; Charlton, Mary E.; Zimmerman, M. Bridget; Goodheart, Michael J.; Zia, Sharaf; Sood, Anil K.; Thaker, Premal H.

doi:10.1016/j.ygyno.2021.07.035

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…We anticipate that provider referrals will be an important contributor to whether a patient is treated by a gynecologic oncologist at centers of excellence, and that receipt of standard of care from such a provider will be strongly associated with ovarian cancer outcomes. 11 , 12 , 14 …”

Section: Discussionmentioning

confidence: 99%

“… 4 , 7–9 Rural patients exhibit later stage at diagnosis and shorter survival than their urban counterparts. 10 , 11 When compared to urban patients, rural patients have less access to high-volume health care facilities and specialty providers capable of providing the complex care needed for ovarian cancer, which includes surgery, treatment, and disease surveillance. 10 , 12 , 13 Rural patients are also less likely to receive surgery from a gynecologic oncologist, which leads to poorer outcomes, despite this being the guideline recommendations of the National Comprehensive Cancer Network (NCCN).…”

Section: Introductionmentioning

confidence: 99%

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

Ulmer

Greteman

McDonald

et al. 2022

Women's Health Reports

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Objectives: Rural ovarian cancer patients experience worse survival compared to urban patients. We assessed whether distance to gynecologic oncology specialists was associated with survival for patients in a rural state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients diagnosed between 1990 and 2018. Data were linked to the county-level 2018–2019 Area Health Resource File (number of surgeons and hospital beds per 100,000 population). Rurality was defined using 2013 Rural-Urban Continuum Codes; distance to the nearest gynecologic oncologist was calculated from the centroid of the county of residence to the centroid of the nearest county with a high volume health care center with a gynecologic oncologist. Associations with survival were assessed using multivariable Cox proportional hazards models. Results: Analyses included 1,562 ovarian cancer patients. Mean distance to gynecologic oncology was 60.8 miles, and median survival was 23 months. Unadjusted models showed increased distance from gynecologic oncology had progressively greater risk of death 30–49 miles (hazard ratio [HR] = 1.09, confidence interval [CI]: 1.04–1.15), 50–69 miles (HR = 1.19, CI: 1.07–1.32), 70+ miles (HR = 1.30, CI: 1.11–1.51). In adjusted models, association of distance to gynecologic oncology with risk of death was not significant; however, more advanced cancer stage and age, unmarried status, and higher county-level poverty were independently associated with increased risk of death. Conclusions: Above and beyond demographics and stage, distance to gynecologic oncology care was not an independent predictor of ovarian cancer survival. Further studies are needed to determine how to mitigate the factors contributing to worsened ovarian cancer survival among rural patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ulmer

Greteman

McDonald

et al. 2022

Women's Health Reports

View full text Add to dashboard Cite

show abstract

“…A study done in 2021 concluded that rural residence and living long distances from the reporting hospital were associated with later-stage diagnoses and lower survival rates in young patients with cancer 16. Similarly, studies have suggested that patients with ovarian cancer living in rural areas present with later stage disease at diagnosis and have shorter survival than their urban counterparts 17 18. Over 99% of gynecological oncology providers in the United States work in metropolitan counties, despite approximately 20% of their patients living in rural counties.…”

Section: Introductionmentioning

confidence: 99%

Disparity of ovarian cancer survival between urban and rural settings

Ulmer

Greteman

Cardillo

et al. 2022

Int J Gynecol Cancer

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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.

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“…However, access to this level of care is not equitable for all patients. Furthermore, even within single academic institutions, patient outcomes have differed based on race, distance lived from the institution, and rural community status ( Dilley et al, 2018 , Petersen et al, 2021 , Lutgendorf et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…This has sparked interest in examining social determinants of ovarian cancer treatment, particularly factors related to cancer care access ( Lutgendorf et al, 2021 , Petersen et al, 2021 , McDonald, 2021 , Daruvala et al, 2021 ). The public health literature has shown that even after controlling for a patient’s individual socioeconomic and health characteristics, their neighborhood environment can independently impact their health outcomes ( Pickett and Pearl, 2001 , Prentice, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Rural residence is related to shorter survival in epithelial ovarian cancer patients

Cited by 18 publications

References 31 publications

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

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

Disparity of ovarian cancer survival between urban and rural settings

Community access to primary care is an important geographic disparity among ovarian cancer patients undergoing cytoreductive surgery

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