Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines

Robert E. Bristow, Jenny Chang, Argyrios Ziogas, Belinda Campos, Leo R. Chavez, Hoda Anton-Culver

Research output: Contribution to journalArticle

Abstract

Objective: To estimate whether race or ethnic and socioeconomic strata are independently associated with advanced-stage ovarian cancer-specific survival after adjusting for adherence to National Comprehensive Cancer Network treatment guidelines. Methods: The design was a retrospective population-based cohort study of patients with stage IIIC-IV epithelial ovarian cancer identified from the Surveillance, Epidemiology, and End Results-Medicare database (1992-2009). Quartile of census tract median household income was used as the measure of socioeconomic status (quartiles 1-4). A multivariable logistic regression model was used to identify characteristics predictive of adherence to National Comprehensive Cancer Network guidelines for surgery and chemotherapy. Cox proportional hazards models and propensity score matching were used for survival analyses. Results: A total of 10,296 patients were identified, and 30.2% received National Comprehensive Cancer Network guideline-adherent care. Among demographic variables, black race (adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.22-1.92) and low socioeconomic status (quartile 1, adjusted OR 1.32, 95% CI 1.14-1.52) were independently associated with nonguideline care. Stratified multivariate survival analysis using the propensity score-matched sample (n5,124) revealed that deviation from treatment guidelines was associated with a comparable risk of disease-related death across race-ethnicity: whites (adjusted hazard ratio [HR] 1.59, 95% CI 1.48-1.71), blacks (adjusted HR 1.66, 95% CI 1.19-2.30), Asian or Pacific Islanders (adjusted HR 1.52, 95% CI 0.99-1.92), and Hispanics (adjusted HR 1.91, 95% CI 0.98-3.72). Across socioeconomic status, deviation from treatment guidelines was also associated with a comparable risk of ovarian cancer mortality for quartile 1 (adjusted HR 1.69, 95% CI 1.47-1.95), quartile 2 (adjusted HR 1.63, 95% CI 1.42-1.87), quartile 3 (adjusted HR 1.51, 95% CI 1.32-1.73), and quartile 4 (adjusted HR 1.57, 95% CI 1.38-1.79). Conclusion: Adherence to treatment guidelines for advanced-stage ovarian cancer is associated with equivalent survival benefit across racial or ethnic and socioeconomic strata. Ensuring equal access to standard treatment is a viable strategic approach to reduce survival disparities.

Original languageEnglish (US)
Pages (from-to)833-842
Number of pages10
JournalObstetrics and Gynecology
Volume125
Issue number4
DOIs
StatePublished - Apr 24 2015
Externally publishedYes

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Ovarian Neoplasms
Guidelines
Confidence Intervals
Survival
Social Class
Therapeutics
Propensity Score
Survival Analysis
Logistic Models
Odds Ratio
Neoplasms
Censuses
Medicare
Hispanic Americans
Proportional Hazards Models
Epidemiology
Cohort Studies
Multivariate Analysis
Demography
Databases

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Bristow, R. E., Chang, J., Ziogas, A., Campos, B., Chavez, L. R., & Anton-Culver, H. (2015). Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines. Obstetrics and Gynecology, 125(4), 833-842. https://doi.org/10.1097/AOG.0000000000000643

Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines. / Bristow, Robert E.; Chang, Jenny; Ziogas, Argyrios; Campos, Belinda; Chavez, Leo R.; Anton-Culver, Hoda.

In: Obstetrics and Gynecology, Vol. 125, No. 4, 24.04.2015, p. 833-842.

Research output: Contribution to journalArticle

Bristow, RE, Chang, J, Ziogas, A, Campos, B, Chavez, LR & Anton-Culver, H 2015, 'Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines', Obstetrics and Gynecology, vol. 125, no. 4, pp. 833-842. https://doi.org/10.1097/AOG.0000000000000643
Bristow, Robert E. ; Chang, Jenny ; Ziogas, Argyrios ; Campos, Belinda ; Chavez, Leo R. ; Anton-Culver, Hoda. / Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines. In: Obstetrics and Gynecology. 2015 ; Vol. 125, No. 4. pp. 833-842.
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abstract = "Objective: To estimate whether race or ethnic and socioeconomic strata are independently associated with advanced-stage ovarian cancer-specific survival after adjusting for adherence to National Comprehensive Cancer Network treatment guidelines. Methods: The design was a retrospective population-based cohort study of patients with stage IIIC-IV epithelial ovarian cancer identified from the Surveillance, Epidemiology, and End Results-Medicare database (1992-2009). Quartile of census tract median household income was used as the measure of socioeconomic status (quartiles 1-4). A multivariable logistic regression model was used to identify characteristics predictive of adherence to National Comprehensive Cancer Network guidelines for surgery and chemotherapy. Cox proportional hazards models and propensity score matching were used for survival analyses. Results: A total of 10,296 patients were identified, and 30.2{\%} received National Comprehensive Cancer Network guideline-adherent care. Among demographic variables, black race (adjusted odds ratio [OR] 1.53, 95{\%} confidence interval [CI] 1.22-1.92) and low socioeconomic status (quartile 1, adjusted OR 1.32, 95{\%} CI 1.14-1.52) were independently associated with nonguideline care. Stratified multivariate survival analysis using the propensity score-matched sample (n5,124) revealed that deviation from treatment guidelines was associated with a comparable risk of disease-related death across race-ethnicity: whites (adjusted hazard ratio [HR] 1.59, 95{\%} CI 1.48-1.71), blacks (adjusted HR 1.66, 95{\%} CI 1.19-2.30), Asian or Pacific Islanders (adjusted HR 1.52, 95{\%} CI 0.99-1.92), and Hispanics (adjusted HR 1.91, 95{\%} CI 0.98-3.72). Across socioeconomic status, deviation from treatment guidelines was also associated with a comparable risk of ovarian cancer mortality for quartile 1 (adjusted HR 1.69, 95{\%} CI 1.47-1.95), quartile 2 (adjusted HR 1.63, 95{\%} CI 1.42-1.87), quartile 3 (adjusted HR 1.51, 95{\%} CI 1.32-1.73), and quartile 4 (adjusted HR 1.57, 95{\%} CI 1.38-1.79). Conclusion: Adherence to treatment guidelines for advanced-stage ovarian cancer is associated with equivalent survival benefit across racial or ethnic and socioeconomic strata. Ensuring equal access to standard treatment is a viable strategic approach to reduce survival disparities.",
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AU - Anton-Culver, Hoda

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N2 - Objective: To estimate whether race or ethnic and socioeconomic strata are independently associated with advanced-stage ovarian cancer-specific survival after adjusting for adherence to National Comprehensive Cancer Network treatment guidelines. Methods: The design was a retrospective population-based cohort study of patients with stage IIIC-IV epithelial ovarian cancer identified from the Surveillance, Epidemiology, and End Results-Medicare database (1992-2009). Quartile of census tract median household income was used as the measure of socioeconomic status (quartiles 1-4). A multivariable logistic regression model was used to identify characteristics predictive of adherence to National Comprehensive Cancer Network guidelines for surgery and chemotherapy. Cox proportional hazards models and propensity score matching were used for survival analyses. Results: A total of 10,296 patients were identified, and 30.2% received National Comprehensive Cancer Network guideline-adherent care. Among demographic variables, black race (adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.22-1.92) and low socioeconomic status (quartile 1, adjusted OR 1.32, 95% CI 1.14-1.52) were independently associated with nonguideline care. Stratified multivariate survival analysis using the propensity score-matched sample (n5,124) revealed that deviation from treatment guidelines was associated with a comparable risk of disease-related death across race-ethnicity: whites (adjusted hazard ratio [HR] 1.59, 95% CI 1.48-1.71), blacks (adjusted HR 1.66, 95% CI 1.19-2.30), Asian or Pacific Islanders (adjusted HR 1.52, 95% CI 0.99-1.92), and Hispanics (adjusted HR 1.91, 95% CI 0.98-3.72). Across socioeconomic status, deviation from treatment guidelines was also associated with a comparable risk of ovarian cancer mortality for quartile 1 (adjusted HR 1.69, 95% CI 1.47-1.95), quartile 2 (adjusted HR 1.63, 95% CI 1.42-1.87), quartile 3 (adjusted HR 1.51, 95% CI 1.32-1.73), and quartile 4 (adjusted HR 1.57, 95% CI 1.38-1.79). Conclusion: Adherence to treatment guidelines for advanced-stage ovarian cancer is associated with equivalent survival benefit across racial or ethnic and socioeconomic strata. Ensuring equal access to standard treatment is a viable strategic approach to reduce survival disparities.

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