Socioeconomic factors may contribute to neoadjuvant chemotherapy use in metastatic epithelial ovarian carcinoma

Chase, Dana M.; Rincon, Alejandrina; Deane, Molly; Tewari, Krishnansu S.; Brewster, Wendy R.

doi:10.1016/j.ygyno.2009.08.008

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…We found a similar pattern in this study, with a strong correlation observed between increasing age and the use of primary chemotherapy. A previous study of women treated with NAC suggested that socioeconomic factors such as race and insurance status may have contributed to the use of NAC[26]. It seems less likely in this cohort that financial obstacles played a large role in the lack of surgery as may be observed in other settings, as patients were all covered by Medicare.…”

Section: Discussionmentioning

confidence: 82%

Trends in treatment of advanced epithelial ovarian cancer in the Medicare population

Thrall

Gray

Symons

et al. 2011

Gynecologic Oncology

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Objective Optimal care for most patients with advanced ovarian cancer generally includes both surgery and chemotherapy. Little is known about the proportion of women in the US who receive combination care or the sequence in which this care is delivered. This study evaluated patterns of care, frequency of completion of recommended therapy and factors associated with sequencing of therapy. Methods Using the Surveillance, Epidemiology and End-Results data we identified a cohort of 8211 women aged 65 and above with stage III/IV epithelial ovarian cancer diagnosed between 1995–2005. Receipt of chemotherapy or surgery was identified using Medicare claims. Logistic regression was used to evaluate factors associated with sequencing of treatment and the receipt of surgery. Results 3241 (39.1%) had surgery and at least 6 cycles of chemotherapy in either order. Surgery was performed initially in 4827 (58.8%) women and 3658/4827 (75.8%) had subsequent chemotherapy. 2017 (24.6%) had primary chemotherapy and 649/2017 (32.2%) of these women had subsequent surgery. Advanced age, African American race, stage IV disease, non-married status and increasing medical comorbidity were all associated with the failure to receive both surgery and at least 6 cycles of chemotherapy (all p<0.01). Conclusions The majority of women with advanced ovarian cancer in the Medicare population do not receive both combination therapy with surgery and at least 6 cycles of chemotherapy. A large proportion of women are receiving chemotherapy as primary treatment for advanced ovarian cancer, and the majority of these patients do not have cancer-directed surgery.

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Section: Discussionmentioning

confidence: 82%

Trends in treatment of advanced epithelial ovarian cancer in the Medicare population

Thrall

Gray

Symons

et al. 2011

Gynecologic Oncology

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“…Of the 41 studies included, 22 examined ovarian treatment outcomes (7–11,13,14,21–35), and 26 studies examined ovarian cancer survival or mortality outcomes (5,9,13–15,26,27,30,34–51). Among the studies that examined treatment, four studies evaluated the receipt of chemotherapy (22,24,26,28), eight studies examined surgical therapy (6,8,21,25,30,31,33,35), and 11 studies examined receipt both of surgery and chemotherapy based on recommended guidelines (7,9–11,13,22,27,29,32–34). Most (n = 21) of the studies included were published between 2011 and 2016 (5,7–11,13,14,30–34,43–48,50,51), 16 studies were published in 2006–2010 (6,15,21,24–29,35,37–42), and four studies were published between 2000 and 2005 (22,23,36,49).…”

Section: Resultsmentioning

confidence: 99%

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

Karanth

Fowler

Mao

et al. 2019

JNCI Cancer Spectrum

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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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“…Another finding in the present study that has not been adequately addressed in previous studies is the association between being divorced/separated and persistent opioid use. In previous studies of socio‐economic associations with drug use, divorced/separated persons have been grouped together with widows/widowers or even, in some studies, with single persons. Based on the results from the present study, it seems inappropriate to combine these heterogeneous groups when studying persistent opioid use because this will tend to attenuate the possible associations.…”

Section: Discussionmentioning

confidence: 99%

Persistent opioid use and socio-economic factors: a population-based study in Norway

Svendsen

Fredheim

Romundstad

et al. 2014

Acta Anaesthesiol Scand

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Socioeconomic factors may contribute to neoadjuvant chemotherapy use in metastatic epithelial ovarian carcinoma

Cited by 8 publications

References 17 publications

Trends in treatment of advanced epithelial ovarian cancer in the Medicare population

Trends in treatment of advanced epithelial ovarian cancer in the Medicare population

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

Persistent opioid use and socio-economic factors: a population-based study in Norway

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