Recent research published in JNCCN–Journal of the National Comprehensive Cancer Network has shown that there are clear disparities when it comes to which ovarian cancer patients are receiving treatment in accordance with expert clinical guidelines that can significantly impact survival outcomes. And these racial disparities persist even when accounting for other factors that affect healthcare access.
The findings were the result of an observational cohort study conducted by a team of researchers from institutions including the Duke University School of Medicine, University of Kentucky, University of Alabama at Birmingham, Emory University, and New York State Department of Health. They analyzed which patients received ovarian cancer care that follows the evidence-based guidelines developed by the National Comprehensive Cancer Network. Known as the NCCN Clinical Practice Guidelines in Oncology for Ovarian Cancer (NCCN Guidelines), these recommendations are developed by clinicians and oncology researchers from the organization’s 32 member institutions. Previous research has shown that ovarian cancer care given in accordance with the NCCN Guidelines has resulted in improved survival rates, yet Black women receive this type of care less often than white women.
“Racial disparities in receipt of guideline-concordant care have been well described,” according to the study’s authors. “Given the well-documented survival advantage associated with receipt of guideline-concordant treatment and the reduced rates of [this] treatment receipt among Black patients, elucidating the healthcare access (HCA) factors driving racial inequities in receipt of [this] care is imperative to help narrow the survival disparity in ovarian cancer.”
The researchers examined whether certain healthcare access factors, including affordability (patient’s ability to pay) and availability (number of hospitals/specialists in the patient’s area), contribute to racial disparities in ovarian cancer care. They conducted an observational cohort study using a Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data set to analyze information collected on 5,632 women aged 65 and older who were diagnosed with ovarian cancer between the years 2008 and 2015. All patients were continuously enrolled in Medicare’s fee-for-service program for at least 12 months before their ovarian cancer diagnosis and 12 months after it. The researchers divided the study group into three different categories by race: non-Hispanic Black, Hispanic, and non-Hispanic white.
According to the researchers’ findings, only 14% of the non-Hispanic Black patients in the study group received both the surgery and the recommended number of chemotherapy cycles recommended by the NCCN Guidelines, as compared with 24% of the non-Hispanic white patients.
“We know that the best outcomes for ovarian cancer are achieved when affected patients are treated according to NCCN Guidelines,” stated Dr. Ronald D. Alvarez in a release issued by NCCN. Dr. Alvarez, who was not involved in this study, is Chair of OCRA’s Scientific Advisory Committee, Chairman and Clinical Service Chief of Obstetrics and Gynecology at the Vanderbilt University Medical Center, and Vice-Chair for the NCCN Guidelines Panel for Ovarian Cancer. “This study demonstrated, similar to many other studies, that non-Hispanic Black ovarian cancer patients were less likely than non-Hispanic white ovarian cancer patients to receive NCCN Guidelines-based care.”
After looking at the data related to the factors that can impact a patient’s healthcare access, the scientists learned that the Black patients in the study group had less affordability and availability of services than the white patients. However, the researchers also concluded that the Black patients in the study group were less likely to initiate systemic therapy compared with white patients, even after accounting for affordability and availability factors.
“While the ability to pay and the number of hospitals and specialists in the area impacts a patient’s cancer care, these do not completely explain racial disparities in ovarian cancer treatment,” noted the study’s lead author Dr. Mary Katherine Montes de Oca, a resident at the Duke University School of Medicine. “More work needs to be done to determine what other factors are contributing to these inequities.”
“The reasons are complex and multifaceted,” explained the study’s senior author Dr. Tomi F. Akinyemiju, Associate Director of Community Outreach, Engagement, and Equity at the Duke Cancer Institute and the Vice-Chair of Diversity and Inclusion of the Department of Population Health Sciences at the Duke University School of Medicine.
“For many reasons, including the legacy of structural racism, Black patients have poorer access to healthcare,” she noted in the NCCN release. “This is related to employment patterns, which predict quality insurance coverage and residential patterns, and in turn, the availability and quality of healthcare resources in predominantly Black neighborhoods. As a society, we need to have tough conversations about access to quality care, and collectively come up with solutions so that having a cancer diagnosis does not become a death sentence for the most vulnerable members of our society.”
Learn more about the study in “Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study,” published November 2022 on the JNCCN site.