Racial Disparities in the Receipt of Guideline Care and Cancer Deaths for Women with Ovarian Cancer

Kathleen A. Cronin, Nadia Howlader, Jennifer L. Stevens, Edward Trimble, Linda C. Harlan, Joan L. Warren

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Black women with ovarian cancer experience worse survival than white women. Receipt of guideline care improves survival, yet care may vary by race. We assessed rates of guideline care and role of guideline treatment on survival disparities. METHODS: This retrospective cohort analysis used the NCI's Patterns of Care data for women diagnosed with ovarian cancer, 2002 and 2011 (weighted n = 3,999), with follow-up through December 12, 2014. Logistic regression included patient characteristics, insurance, and gynecologic oncologist (GO) consultation to produce adjusted standardized percentages of women receiving guideline treatment by race. Cox proportional hazards analysis assessed risk of ovarian cancer death. RESULTS: Guideline care was significantly lower for black women compared with white women (adjusted 27.5% vs. 34.1%). Increased receipt of guideline care was associated with GO consultation, younger ages, stage, and insurance. Rates of GO consultation were comparable for black and white women, approximately 60%. Black women were more likely to receive no surgery or no chemotherapy if they did not consult a GO. The unadjusted death risk was significantly higher in black women (HR = 1.33). After adjusting for receipt of guideline care and other factors, black and white women had similar risk of death (HR = 1.05). CONCLUSIONS: Race was not associated with risk of death when guideline care was included in multivariate survival models. However, black patients received less guideline care. GO consultation significantly increased receipt of guideline care. IMPACT: Research is needed to understand treatment perspectives for black patients and their providers to increase the receipt of guideline care and reduce survival disparities.

Original languageEnglish (US)
Pages (from-to)539-545
Number of pages7
JournalCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume28
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Fingerprint

Ovarian Neoplasms
Guidelines
Neoplasms
Referral and Consultation
Survival
Insurance
Cohort Studies
Therapeutics
Logistic Models
Oncologists
Drug Therapy

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Racial Disparities in the Receipt of Guideline Care and Cancer Deaths for Women with Ovarian Cancer. / Cronin, Kathleen A.; Howlader, Nadia; Stevens, Jennifer L.; Trimble, Edward; Harlan, Linda C.; Warren, Joan L.

In: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Vol. 28, No. 3, 01.03.2019, p. 539-545.

Research output: Contribution to journalArticle

@article{d59d1d52d54c488fad3e332b12bda668,
title = "Racial Disparities in the Receipt of Guideline Care and Cancer Deaths for Women with Ovarian Cancer",
abstract = "BACKGROUND: Black women with ovarian cancer experience worse survival than white women. Receipt of guideline care improves survival, yet care may vary by race. We assessed rates of guideline care and role of guideline treatment on survival disparities. METHODS: This retrospective cohort analysis used the NCI's Patterns of Care data for women diagnosed with ovarian cancer, 2002 and 2011 (weighted n = 3,999), with follow-up through December 12, 2014. Logistic regression included patient characteristics, insurance, and gynecologic oncologist (GO) consultation to produce adjusted standardized percentages of women receiving guideline treatment by race. Cox proportional hazards analysis assessed risk of ovarian cancer death. RESULTS: Guideline care was significantly lower for black women compared with white women (adjusted 27.5{\%} vs. 34.1{\%}). Increased receipt of guideline care was associated with GO consultation, younger ages, stage, and insurance. Rates of GO consultation were comparable for black and white women, approximately 60{\%}. Black women were more likely to receive no surgery or no chemotherapy if they did not consult a GO. The unadjusted death risk was significantly higher in black women (HR = 1.33). After adjusting for receipt of guideline care and other factors, black and white women had similar risk of death (HR = 1.05). CONCLUSIONS: Race was not associated with risk of death when guideline care was included in multivariate survival models. However, black patients received less guideline care. GO consultation significantly increased receipt of guideline care. IMPACT: Research is needed to understand treatment perspectives for black patients and their providers to increase the receipt of guideline care and reduce survival disparities.",
author = "Cronin, {Kathleen A.} and Nadia Howlader and Stevens, {Jennifer L.} and Edward Trimble and Harlan, {Linda C.} and Warren, {Joan L.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1158/1055-9965.EPI-18-0285",
language = "English (US)",
volume = "28",
pages = "539--545",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1055-9965",
publisher = "American Association for Cancer Research Inc.",
number = "3",

}

TY - JOUR

T1 - Racial Disparities in the Receipt of Guideline Care and Cancer Deaths for Women with Ovarian Cancer

AU - Cronin, Kathleen A.

AU - Howlader, Nadia

AU - Stevens, Jennifer L.

AU - Trimble, Edward

AU - Harlan, Linda C.

AU - Warren, Joan L.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: Black women with ovarian cancer experience worse survival than white women. Receipt of guideline care improves survival, yet care may vary by race. We assessed rates of guideline care and role of guideline treatment on survival disparities. METHODS: This retrospective cohort analysis used the NCI's Patterns of Care data for women diagnosed with ovarian cancer, 2002 and 2011 (weighted n = 3,999), with follow-up through December 12, 2014. Logistic regression included patient characteristics, insurance, and gynecologic oncologist (GO) consultation to produce adjusted standardized percentages of women receiving guideline treatment by race. Cox proportional hazards analysis assessed risk of ovarian cancer death. RESULTS: Guideline care was significantly lower for black women compared with white women (adjusted 27.5% vs. 34.1%). Increased receipt of guideline care was associated with GO consultation, younger ages, stage, and insurance. Rates of GO consultation were comparable for black and white women, approximately 60%. Black women were more likely to receive no surgery or no chemotherapy if they did not consult a GO. The unadjusted death risk was significantly higher in black women (HR = 1.33). After adjusting for receipt of guideline care and other factors, black and white women had similar risk of death (HR = 1.05). CONCLUSIONS: Race was not associated with risk of death when guideline care was included in multivariate survival models. However, black patients received less guideline care. GO consultation significantly increased receipt of guideline care. IMPACT: Research is needed to understand treatment perspectives for black patients and their providers to increase the receipt of guideline care and reduce survival disparities.

AB - BACKGROUND: Black women with ovarian cancer experience worse survival than white women. Receipt of guideline care improves survival, yet care may vary by race. We assessed rates of guideline care and role of guideline treatment on survival disparities. METHODS: This retrospective cohort analysis used the NCI's Patterns of Care data for women diagnosed with ovarian cancer, 2002 and 2011 (weighted n = 3,999), with follow-up through December 12, 2014. Logistic regression included patient characteristics, insurance, and gynecologic oncologist (GO) consultation to produce adjusted standardized percentages of women receiving guideline treatment by race. Cox proportional hazards analysis assessed risk of ovarian cancer death. RESULTS: Guideline care was significantly lower for black women compared with white women (adjusted 27.5% vs. 34.1%). Increased receipt of guideline care was associated with GO consultation, younger ages, stage, and insurance. Rates of GO consultation were comparable for black and white women, approximately 60%. Black women were more likely to receive no surgery or no chemotherapy if they did not consult a GO. The unadjusted death risk was significantly higher in black women (HR = 1.33). After adjusting for receipt of guideline care and other factors, black and white women had similar risk of death (HR = 1.05). CONCLUSIONS: Race was not associated with risk of death when guideline care was included in multivariate survival models. However, black patients received less guideline care. GO consultation significantly increased receipt of guideline care. IMPACT: Research is needed to understand treatment perspectives for black patients and their providers to increase the receipt of guideline care and reduce survival disparities.

UR - http://www.scopus.com/inward/record.url?scp=85062391793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062391793&partnerID=8YFLogxK

U2 - 10.1158/1055-9965.EPI-18-0285

DO - 10.1158/1055-9965.EPI-18-0285

M3 - Article

C2 - 30487136

AN - SCOPUS:85062391793

VL - 28

SP - 539

EP - 545

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

SN - 1055-9965

IS - 3

ER -