Ovarian-cancer treatment's deadly disparities

Study finds patients who are poor, elderly or from communities of color are most likely to receive inadequate care
Dr. Barbara Goff
Dr. Barbara Goff and colleagues found that women who are elderly, poor or in communities of color are at greatest risk for undertreatment for ovarian cancer, one of the deadliest malignancies in the United States. Photo by Stephanie Cartier

One in three ovarian-cancer patients in the United States fails to receive the recommended comprehensive surgical treatment, according to a new study led by Dr. Barbara Goff of the Clinical Research Division and Seattle Cancer Care Alliance. The review of hospital data from nine states found that women in elderly, poor or communities of color — specifically, those past 70, African American or Hispanic, or Medicaid-insured — were at greatest risk for undertreatment.

In addition, the researchers found that women treated by non-gynecological oncologists, by surgeons who perform few ovarian-cancer surgeries, and at facilities that perform fewer than 10 procedures per year were less likely to receive recommended surgical care.

Goff conducted the research with her colleagues in the University of Washington's Department of Obstetrics and Gynecology. The findings appeared in the May 15 issue of Cancer.

Ovarian cancer is one of the deadliest malignancies for U.S. women, taking the lives of more than 14,000 every year. Diagnosis of the disease generally takes place at an advanced stage, and five-year survival is only 30 percent to 40 percent when all of the cancer is removed; the rate falls to 15 percent or less when residual disease remains after surgery.

Previous research found that women who receive care from a gynecologic oncologist who does a high volume of surgery, at a hospital that performs a large volume of ovarian-cancer surgeries, or at a teaching hospital have significantly better short-term and long-term outcomes.

However, this study's authors report that only 67 percent of the 10,432 women whose cases they reviewed received the recommended comprehensive surgical procedures. The study found 42 percent of patients were treated at teaching hospitals, while a third were treated at a hospital that performed fewer than 10 ovarian cancer surgeries per year. Analysis of the surgeon's attributes showed that physicians who performed fewer than 10 procedures per year treated almost half of the women, and surgeons who perform only one ovarian-cancer surgery annually cared for 25 percent.

The study also identified several patient factors that predicted the likelihood of a patient receiving comprehensive surgical care, including being under 50, Caucasian, privately insured and having an advanced tumor.

"Based on these findings, we recommend that all ovarian-cancer patients, especially those who are vulnerable because of age, race or poverty, be referred to centers or surgeons with higher surgery rates," Goff said.

The Centers for Disease Control and Prevention and the National Cancer Institute through the Cancer Prevention and Control Research Network contributed funding to the study.

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