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Showing content from https://pubmed.ncbi.nlm.nih.gov/24680770/ below:

Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status

Affiliations

• ¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA. Electronic address: rbristow@uci.edu.
• ² Department of Epidemiology, University of California, Irvine, Irvine, CA, USA.

• PMID: 24680770
• PMCID: PMC4095874
• DOI: 10.1016/j.ygyno.2014.03.561

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Robert E Bristow et al. Gynecol Oncol. 2014 Jul.

• ¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA. Electronic address: rbristow@uci.edu.
• ² Department of Epidemiology, University of California, Irvine, Irvine, CA, USA.

• PMID: 24680770
• PMCID: PMC4095874
• DOI: 10.1016/j.ygyno.2014.03.561

Item in Clipboard

Objective: To determine the impact of geographic location on advanced-stage ovarian cancer care adherence to the National Comprehensive Cancer Network (NCCN) guidelines in relation to race and socioeconomic status (SES).

Methods: Patients diagnosed with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Generalized additive models were created to assess the effect of spatial distributions of geographic location, proximity to a high-volume hospital (≥20 cases/year), distance traveled to receive care, race, and SES on adherence to NCCN guidelines, with simultaneous smoothing of geographic location and adjustment for confounding variables. Disparities in geographic predictors of treatment adherence were analyzed with the x(2) test for equality of proportions.

Results: Of the 11,770 patients identified, 45.4% were treated according to NCCN guidelines. Black race (OR=1.49, 95%CI=1.21-1.83), low-SES (OR=1.46, 95%CI=1.24-1.72), and geographic location ≥80 km/50 mi from a high-volume hospital (OR=1.88, 95%CI=1.61-2.19) were independently associated with an increased risk of non-adherent care, while high-volume hospital treatment (OR=0.59, 95%CI=0.53-0.66) and travel distance to receive care ≥32 km/20 mi (OR=0.80, 95%CI=0.69-0.92) were independently protective. SES was inversely associated with location ≥80 km/50 mi from a high-volume hospital, ranging from 6.3% (high-SES) to 33.0% (low-SES) (p<0.0001). White patients were significantly more likely to travel ≥32 km/20 mi to receive care (21.8%) compared to Blacks (14.4%), Hispanics (15.9%), and Asian/Pacific Islanders (15.5%) (p<0.0001).

Conclusion: Geographic proximity to a high-volume hospital and travel distance to receive treatment are independently associated with NCCN guideline adherent care for advanced-stage ovarian cancer. Geographic barriers to standard ovarian cancer treatment disproportionately affect racial minorities and women of low-SES.

Keywords: Geographic location; Ovarian cancer; Treatment guidelines.

Copyright © 2014 Elsevier Inc. All rights reserved.

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(A) Geographic distribution of 11,770…

(A) Geographic distribution of 11,770 cases of stage IIIC/IV epithelial ovarian cancer stratified…

(A) Geographic distribution of 11,770 cases of stage IIIC/IV epithelial ovarian cancer stratified by adherence and non-adherence to NCCN treatment guidelines for advanced-stage ovarian cancer; (B) Geographic distribution of hospitals stratified by high-volume (n=12) and low-volume hospital (n=366).

(A) Geographic distribution of 11,770…

(A) Geographic distribution of 11,770 cases of stage IIIC/IV epithelial ovarian cancer stratified…

(A) Geographic distribution of 11,770 cases of stage IIIC/IV epithelial ovarian cancer stratified by adherence and non-adherence to NCCN treatment guidelines for advanced-stage ovarian cancer; (B) Geographic distribution of hospitals stratified by high-volume (n=12) and low-volume hospital (n=366).

Effect of geographic location on…

Effect of geographic location on risk of non-adherence to NCCN treatment guidelines.

Effect of geographic location on risk of non-adherence to NCCN treatment guidelines.

Radar plot: proportional distribution of…

Radar plot: proportional distribution of subject location and distance to receive care quintile…

Radar plot: proportional distribution of subject location and distance to receive care quintile stratified by race (A) and SES category (B). API: Asian/Pacific Islander

Radar plot: proportional distribution of…

Radar plot: proportional distribution of subject location and distance to receive care quintile…

Radar plot: proportional distribution of subject location and distance to receive care quintile stratified by race (A) and SES category (B). API: Asian/Pacific Islander

Radar plot: proportional distribution of…

Radar plot: proportional distribution of subject location and distance from a high-volume hospital…

Radar plot: proportional distribution of subject location and distance from a high-volume hospital quintile stratified by race (A) and SES (B). API: Asian/Pacific Islander

Radar plot: proportional distribution of…

Radar plot: proportional distribution of subject location and distance from a high-volume hospital…

Radar plot: proportional distribution of subject location and distance from a high-volume hospital quintile stratified by race (A) and SES (B). API: Asian/Pacific Islander

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  Bristow RE, Chang J, Ziogas A, Gillen DL, Bai L, Vieira VM. Bristow RE, et al. Am J Obstet Gynecol. 2015 Jul;213(1):43.e1-43.e8. doi: 10.1016/j.ajog.2015.01.045. Epub 2015 Jan 31. Am J Obstet Gynecol. 2015. PMID: 25644440 Free PMC article.

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

  Bristow RE, Chang J, Ziogas A, Campos B, Chavez LR, Anton-Culver H. Bristow RE, et al. Obstet Gynecol. 2015 Apr;125(4):833-842. doi: 10.1097/AOG.0000000000000643. Obstet Gynecol. 2015. PMID: 25751200 Free PMC article.

• Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California.

  Long B, Chang J, Ziogas A, Tewari KS, Anton-Culver H, Bristow RE. Long B, et al. Am J Obstet Gynecol. 2015 Apr;212(4):468.e1-9. doi: 10.1016/j.ajog.2014.10.1104. Epub 2014 Oct 31. Am J Obstet Gynecol. 2015. PMID: 25448522

• Contribution of Geographic Location to Disparities in Ovarian Cancer Treatment.

  Villanueva C, Chang J, Bartell SM, Ziogas A, Bristow R, Vieira VM. Villanueva C, et al. J Natl Compr Canc Netw. 2019 Nov 1;17(11):1318-1329. doi: 10.6004/jnccn.2019.7325. J Natl Compr Canc Netw. 2019. PMID: 31693984 Free PMC article.

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  Bristow RE, Powell MA, Al-Hammadi N, Chen L, Miller JP, Roland PY, Mutch DG, Cliby WA. Bristow RE, et al. J Natl Cancer Inst. 2013 Jun 5;105(11):823-32. doi: 10.1093/jnci/djt065. Epub 2013 Mar 28. J Natl Cancer Inst. 2013. PMID: 23539755 Free PMC article.

• Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment.

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• Predictors of survival trajectories among women with epithelial ovarian cancer.

  Peres LC, Sinha S, Townsend MK, Fridley BL, Karlan BY, Lutgendorf SK, Shinn E, Sood AK, Tworoger SS. Peres LC, et al. Gynecol Oncol. 2020 Feb;156(2):459-466. doi: 10.1016/j.ygyno.2019.12.011. Epub 2019 Dec 12. Gynecol Oncol. 2020. PMID: 31839342 Free PMC article.

• Impact of hospital volume on racial disparities and outcomes for endometrial cancer.

  Buskwofie A, Huang Y, Tergas AI, Hou JY, Ananth CV, Neugut AI, Hershman DL, Wright JD. Buskwofie A, et al. Gynecol Oncol. 2018 May;149(2):329-336. doi: 10.1016/j.ygyno.2018.02.019. Epub 2018 Mar 2. Gynecol Oncol. 2018. PMID: 29506862 Free PMC article.

• Spatial analysis of advanced-stage ovarian cancer mortality in California.

  Bristow RE, Chang J, Ziogas A, Gillen DL, Bai L, Vieira VM. Bristow RE, et al. Am J Obstet Gynecol. 2015 Jul;213(1):43.e1-43.e8. doi: 10.1016/j.ajog.2015.01.045. Epub 2015 Jan 31. Am J Obstet Gynecol. 2015. PMID: 25644440 Free PMC article.

• Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996-2014.

  Villanueva C, Chang J, Ziogas A, Bristow RE, Vieira VM. Villanueva C, et al. Cancer Epidemiol. 2020 Dec;69:101825. doi: 10.1016/j.canep.2020.101825. Epub 2020 Oct 3. Cancer Epidemiol. 2020. PMID: 33022472 Free PMC article.

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