May 8, 2012
UCI Study Finds Racial, Economic Disparities In Ovarian Cancer Care, Survival
White and affluent women did better than African American and poor women
Poor women and African Americans with ovarian cancer are less likely to receive the highest standards of care, leading to worse outcomes than among white and affluent patients, according to a study of 50,000 women presented by UC Irvine´s Dr. Robert Bristow at the Society of Gynecologic Oncology´s annual meeting March 27.
“Not all women are benefiting equally from improvements in ovarian cancer care,” said Bristow, UC Irvine´s director of gynecologic oncology services. “The reasons behind these disparities are not entirely clear, which is why we need additional research.”
The study´s goal was to examine differences related to race and socioeconomic status among women being treated for epithelial ovarian carcinomas — cancer that forms on the surface of an ovary. It also aimed to determine whether their care adhered to National Comprehensive Cancer Network treatment guidelines.
Bristow and colleagues found that five-year survival rates varied significantly. (Improvement in ovarian cancer care is measured in length of survival after diagnosis rather than a “cure” rate.)
Among those whose care met NCCN standards, the rate for white women was 41.4 percent, compared with 33.3 percent for African American women. Among those whose care did not meet NCCN standards, the rate for white women was 37.8 percent, compared with 22.5 percent for African American women.
Bristow said that women on Medicaid or those with no insurance had a 30 percent increased risk of death. Poor women — defined as having an annual household income of less than $35,000 — had worse survival rates regardless of race.
He said it´s likely that the effects of race and socioeconomic status are cumulative and that some combination of other medical conditions, poverty, culture and social injustice accounts for the majority of observed disparities.
Ovarian cancer is the deadliest gynecologic cancer, accounting for more than 15,000 deaths a year, according to the National Cancer Institute.
“Under the best circumstances, treating ovarian cancer is challenging, because there´s no screening tool available to detect the disease in its early stages,” Bristow said.
Only 20 to 30 percent of ovarian cancers are diagnosed while still confined to the primary site; the remainder are identified in advanced stages after spreading to areas such as the liver, the lungs and nearby lymph nodes.
Bristow´s study was part of an effort by the Society of Gynecologic Oncology and colleagues at the Mayo Clinic and Washington University in St. Louis to assess the quality and outcomes of ovarian cancer care in the U.S.
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