RetroSearch Browse

Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from https://pubmed.ncbi.nlm.nih.gov/23539755/ below:

Disparities in ovarian cancer care quality and survival according to race and socioeconomic status

. 2013 Jun 5;105(11):823-32. doi: 10.1093/jnci/djt065. Epub 2013 Mar 28. Disparities in ovarian cancer care quality and survival according to race and socioeconomic status

Affiliations

Affiliation

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA. rbristow@uci.edu

PMID: 23539755
PMCID: PMC3691950
DOI: 10.1093/jnci/djt065

Item in Clipboard

Disparities in ovarian cancer care quality and survival according to race and socioeconomic status

Robert E Bristow et al. J Natl Cancer Inst. 2013.

. 2013 Jun 5;105(11):823-32. doi: 10.1093/jnci/djt065. Epub 2013 Mar 28. Affiliation

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA. rbristow@uci.edu

PMID: 23539755
PMCID: PMC3691950
DOI: 10.1093/jnci/djt065

Item in Clipboard

Abstract

Background: The relationship between racial and socioeconomic status (SES) disparities and the quality of epithelial ovarian cancer care and survival outcome are unclear.

Methods: A population-based analysis of National Cancer Data Base (NCDB) records for invasive primary epithelial ovarian cancer diagnosed in the period from 1998 to 2002 was done using data from patients classified as white or black. Adherence to National Comprehensive Cancer Network (NCCN) guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. The main outcome measures were differences in adherence to NCCN guidelines and overall survival according to race and SES and were analyzed using binomial logistic regression and multilevel survival analysis.

Results: A total of 47 160 patients (white = 43 995; black = 3165) were identified. Non-NCCN-guideline-adherent care was an independent predictor of inferior overall survival (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.38 to 1.47). Demographic characteristics independently associated with a higher likelihood of not receiving NCCN guideline-adherent care were black race (odds ratio [OR] = 1.36, 95% CI = 1.25 to 1.48), Medicare payer status (OR = 1.20, 95% CI = 1.12 to 1.28), and not insured payer status (OR = 1.33, 95% CI = 1.19 to 1.49). After controlling for disease and treatment-related variables, independent racial and SES predictors of survival were black race (HR = 1.29, 95% CI = 1.22 to 1.36), Medicaid payer status (HR = 1.29, 95% CI = 1.20 to 1.38), not insured payer status (HR = 1.32, 95% CI = 1.20 to 1.44), and median household income less than $35 000 (HR = 1.06, 95% CI = 1.02 to 1.11).

Conclusions: These data highlight statistically and clinically significant disparities in the quality of ovarian cancer care and overall survival, independent of NCCN guidelines, along racial and SES parameters. Increased efforts are needed to more precisely define the patient, provider, health-care system, and societal factors leading to these observed disparities and guide targeted interventions.

PubMed Disclaimer

Figures
Figure 1.

Overall survival (OS) probability for…

Figure 1.

Overall survival (OS) probability for patients with invasive primary epithelial ovarian cancer from…

Figure 1.

Overall survival (OS) probability for patients with invasive primary epithelial ovarian cancer from the National Cancer Data Base stratified by adherence to National Comprehensive Cancer Network (NCCN) guideline therapy and race and payer category. Survival analyses were performed using the Kaplan–Meier method and two-sided log rank test. A) Data from all patients (n = 47 160) were analyzed according to race and adherence and nonadherence to NCCN guideline care. The 5-year overall survival was 41.4% (95% confidence interval [CI] = 40.6% to 42.1%) for adherent whites, 33.3% (95% CI = 30.4% to 36.2%) for adherent blacks, 37.8% (95% CI = 37.1% to 38.4%) for nonadherent whites, and 22.5% (95% CI = 20.6% to 24.4%) for nonadherent blacks (two-sided P < .001). B) Data from all patients receiving NCCN guideline-adherent therapy (n = 20 432) were analyzed according to payer category. The 5-year overall survival was 46.3% (95% CI = 44.8% to 47.8%) for patients with private payer category, 47.3% (95% CI = 46.0% to 48.5%) for patients with managed care payer category, 31.6% (95% CI = 30.4% to 32.7%) for patients with Medicare payer category, 35.8% (95% CI = 32.4% to 39.3%) for patients with Medicaid payer category, and 42.4% (95% CI = 38.4% to 46.4%) for patients with not insured/self pay payer category (two-sided P < .001). The number of patients at risk in each group at various time points are listed below the graphs.