Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status

Abstract

OBJECTIVE To determine the impact of geographic location on advanced-stage ovarian cancer care adherence to National Comprehensive Cancer Network (NCCN) guidelines in relation to race and socioeconomic status (SES). METHODS Patients diagnosed with Stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Generalized additive models were created to assess the effect of spatial distributions of geographic location, proximity to a high-volume hospital (≥20 cases/year), distance travelled to receive care, race, and SES on adherence to NCCN guidelines, with simultaneous smoothing of geographic location and adjustment for confounding variables. Disparities in geographic predictors of treatment adherence were analyzed with the χ2 test for equality of proportions. RESULTS Of the 11,770 patients identified, 45.4% were treated according to NCCN guidelines. Black race (OR=1.49, 95%CI=1.21-1.83), low-SES (OR=1.46, 95%CI=1.24-1.72), and geographic location ≥80km/50mi from a high-volume hospital (OR=1.88, 95%CI=1.61-2.19) were independently associated with an increased risk of non-adherent care, while high-volume hospital treatment (OR=0.59, 95%CI=0.53-0.66) and travel distance to receive care ≥32km/20mi (OR=0.80, 95%CI=0.69-0.92) were independently protective. SES was inversely associated with location ≥80km/50mi from a high-volume hospital, ranging from 6.3% (high-SES) to 33.0% (low-SES) (p<0.0001). White patients were significantly more likely to travel ≥32km/20mi to receive care (21.8%) compared to Blacks (14.4%), Hispanics (15.9%), and Asian/Pacific Islanders (15.5%) (p<0.0001). CONCLUSION Geographic proximity to a high-volume hospital and travel distance to receive treatment are independently associated with NCCN guideline adherent care for advanced-stage ovarian cancer. Geographic barriers to standard ovarian cancer treatment disproportionately affect racial minorities and women of low-SES.

Spatial epidemiology of cancer: a review of data sources, methods and risk factors

“…Individual data Cancer registries Aballay et al (2012), Absalon and Slesak (2011), Al-Ahmadi and Al-Zahrani (2013), Alvarez et al (2009), Bailony et al (2011), Bambhroliya et al (2012, Bristow et al (2014), Buntinx et al (2003), Cassetti et al (2008), Chen et al (2008b, 2011, Chien et al (2013a), Christian et al (2011), Colak et al (2015, Colonna (2004Colonna ( , 2006, Colonna et al (1990), Cramb et al (2011), Dai and Oyana (2008), David et al (2002), DeChello and Sheehan (2007), DeChello et al (2006), Drapeau et al (1995), Elebead et al (2012), Elferink et al (2012), Fairley et al (2008), Fedewa et al (2009), Ferreira et al (2012, Fortunato et al (2011), Gallagher et al (2010, Garcia Martinez et al (2014), Gbary et al (1995), Goodman et al (2010), Xiao (2011, 2012), Guajardo and Oyana (2009), Samociuk (2003, 2013) Godon et al (1991), Goovaerts (2005Goovaerts ( , 2006aGoovaerts ( , 2006b), Hendryx et al (2010), Hosseintabar Marzoni et al (2015, …”

Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

“…For example, women with breast cancer are more likely to present with advanced staged disease, less likely to receive breast conserving surgery and less likely to receive postoperative adjuvant care as the distance from their home to a health care facility increases [13,[15][16][17][18]. For women with ovarian cancer, geographic proximity to a high-volume hospital has been shown to be independently associated with receipt of NCCN-adherent care in California [19].…”

Geographic access to gynecologic cancer care in the United States

“…Previous studies correlating place of residence to gynecologic cancer outcomes at the state level may have been limited by boundary effects; patients who live at the periphery of a state may have sought care across state borders and therefore were not captured by analysis of in-state datasets [10,11]. Nationwide analysis nearly eliminates this problem.…”

“…A 50-mile cutoff was selected for further analysis based on decreased utilization of high-quality care at this distance as discussed above [10,11], and based on preliminary exploratory analysis suggesting that close to 10% of the US female population live further than 50 miles from the closest gynecologic oncologist (Table 1). Counties whose residents are greater than 50 miles from the nearest gynecologic oncologist were designated low access counties (LACs).…”

“…This standard is further supported by data associating treatment by a gynecologic oncologist with superior clinical Gynecologic Oncology 138 (2015) 115-120 outcomes, primarily in the context of ovarian cancer [7][8][9]. Analyses of state cancer registries by Bristow et al (California) [10] and Gunderson et al (Maryland) [11] noted a significant decline in likelihood of utilizing high-volume care for ovarian and uterine cancers, respectively, when patients' residences were more than 50 miles from the nearest high-volume center. Likewise, Tracey et al found that increasing distance of residence from specialty hospitals in New South Wales, Australia correlated with decreased utilization of specialized gynecologic oncology care [12], and Tan et al found an increase in cervical and endometrial cancer mortality associated with increased distance from a gynecologic oncology center [13].…”