Racial Disparities in the Treatment of Advanced Epithelial Ovarian Cancer

Howell, Elizabeth A. MD, MPP; Egorova, Natalia PhD; Hayes, Monica P. MD; Wisnivesky, Juan MD, PH; Franco, Rebeca MPH; Bickell, Nina MD, MPH

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182a92011
Original Research
Abstract

OBJECTIVE: To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer.

METHODS: We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995–2007. We evaluated long-term survival for 4,695 black and white women with stage III or stage IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment.

RESULTS: Black women with advanced epithelial ovarian cancer were more likely to die than white women (unadjusted hazard ratio [HR] 1.27; 95% confidence interval [CI] 1.10–1.46). Black women were less likely than white women to receive guideline-recommended care (54% compared with 68%; P<.001), and women who did not receive recommended treatment had lower survival rates than women who received recommended care. Cox proportional hazards models demonstrated no differences in black women compared with white women regarding mortality among women who were treated with guideline-recommended care (adjusted HR 1.04; 95% CI 0.85–1.26), or among women who received incomplete treatment (adjusted HR 1.09; 95% CI 0.89–1.34). The survival analysis of patients matched by propensity score confirmed these analyses.

CONCLUSIONS: Differences in rates of treatment with guideline-recommended care are associated with black–white mortality disparities among women with advanced epithelial ovarian cancer.

LEVEL OF EVIDENCE: III

In Brief

Differences in rates of treatment with guideline-recommended care are associated with black&amp;#x2013;white mortality disparities among women with advanced epithelial ovarian cancer.

Author Information

Departments of Health Evidence & Policy, Obstetrics, Gynecology, and Reproductive Science, and Medicine, Mount Sinai School of Medicine, New York, New York.

Corresponding author: Dr. Elizabeth A. Howell, Department of Health Evidence & Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1077, New York, NY 10029-6574; e-mail: elizabeth.howell@mountsinai.org.

Supported by the National Cancer Institute (1RO1CA157176-01).

Presented at the Academy Health Annual Research Meeting, 25 June 2012, Orlando, Florida.

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development, and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

Financial Disclosure Dr. Wisnivesky is a member of the research board of EHE International, has received consulting honorarium from Merck Pharmaceutical, UBS, and IMS Health, and has a research grant from GlaxoSmithKline. The other authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.