Age, Race, and Income Level Associated with Undertreatment of Ovarian Cancer
Adapted from the NCI Cancer Bulletin.
Women with ovarian cancer who are aged 70 and older, African American or Hispanic, or insured by Medicaid were less likely to receive the recommended comprehensive surgical treatment, according to study results in the May 15, 2007 journal Cancer (published online April 9).
Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States, accounting for more than 14,000 deaths each year. Providing comprehensive surgical treatment for women with ovarian cancer, which is often diagnosed at advanced stages, is one of the most effective ways to improve survival outcomes.
Dr. Barbara Goff of the University of Washington, Seattle, and colleagues analyzed hospital admissions data of 10,432 women aged 21 and older who were diagnosed with ovarian cancer and underwent surgical removal of their ovaries (oophorectomy). Researchers identified patients across nine states from 1999 to 2002 using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project's state inpatient databases, which contain discharge information, such as demographics, place of residence, and diagnosis.
Researchers found that 66.9 percent of the patients received comprehensive surgical treatment (oophorectomy plus surgical removal of all visible extra-ovarian tumors). Women who were 70 or older, African American or Hispanic, or Medicaid patients were all less likely to receive comprehensive surgery compared with women who were between the age of 21 and 50, Caucasian, and had private insurance. Women in hospitals with obstetrics-gynecology teaching programs were also more likely than women in nonteaching hospitals to receive comprehensive surgery. Surgeons that performed fewer than 10 ovarian cancer surgeries per year were significantly less likely to provide comprehensive surgical care.The authors noted, "Because optimal surgery with cytoreduction is associated with improved overall survival, efforts should be made to ensure that all women with ovarian cancer, especially those who are vulnerable because of age, race, or socioeconomic status, are referred to centers or surgeons from whom they are more likely to get optimal surgery."