Disparities in ovarian cancer treatment and overall survival according to race: An update.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5552-5552
Author(s):  
Deanna Huffman ◽  
Thejus Thayyil Jayakrishnan ◽  
Karthik Shankar ◽  
Chelsea Peterson ◽  
Rodney E. Wegner
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Black Women ◽  
White Women ◽  
Disease Stage ◽  
Black Race ◽  
Nccn Guidelines ◽  
Socioeconomic Characteristics ◽  
Black Patients ◽  
White Patients

5552 Background: It has long been identified that black women with ovarian cancer have worse overall survival when compared to white women. Disparities in the adherence to NCCN guideline-directed treatment and socioeconomic characteristics may be responsible for the differences in these outcomes. Methods: A retrospective review of National Cancer Database (NCDB) was performed to identify patients diagnosed with ovarian cancer from 2012-2016. We defined adherence to NCCN (National Comprehensive Cancer Network) guidelines as having stage and year-appropriate chemotherapy and surgery. Differences in guideline adherence, socioeconomic characteristics and survival outcomes were assessed. Results: In total, 32,163 were identified meeting the study criteria; 27,744 identified their race as “white” and 2,204 identified their race as “black”. Characteristics associated with higher likelihood of black race were advanced stage of disease- stage III (OR = 1.1869, CI = 1.03-1.37) or stage IV disease (OR = 1.4495, CI = 1.23-1.70) and treatment in a comprehensive (OR = 1.5757, CI = 1.16-2.15) or academic (OR = 2.3023, CI = 1.70-3.12) treatment facility. Variables associated with a lower likelihood of black race were higher education level (OR for high school degree < 6.5 % = 0.2501, CI = 0.21-0.30) and higher median household income (OR for income > $63,333 = 0.4218, CI = 0.36-0.49). Whether the care received was adherent to NCCN guidelines did not seem to be associated with black race (OR for adherence = 1.0021, CI = 0.89-1.13). 5-year overall survival for patients who received adherent care was 58% for white patients vs. 49% for black patients. Among those who didn’t receive adherent care, the outcomes were 49% among white patients vs. 38% among black patients. Conclusions: Overall survival remains worse for black patients, regardless of whether their care adhered to NCCN guidelines as defined by our study. This suggests that while receipt of care that is not adherent to NCCN guidelines seems to be negatively associated with overall survival, we must consider and evaluate other socioeconomic, environmental and system factors that are contributing to this continued survival discrepancy in women being treated for ovarian cancer.

scholarly journals Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy

2016 ◽  
Vol 34 (36) ◽  
pp. 4398-4404 ◽  
Author(s):  
Alana Biggers ◽  
Yushu Shi ◽  
John Charlson ◽  
Elizabeth C. Smith ◽  
Alicia J. Smallwood ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Hormonal Therapy ◽  
Low Income ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Purpose To investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity. Methods A nationwide cohort of women age ≥ 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments. Results Among the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women. Conclusion Receipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.

Racial disparities in receipt of guideline care and cancer deaths for women with ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18081-e18081 ◽  
Author(s):  
Joan Warren ◽  
Kathleen A Cronin ◽  
Jennifer Stevens ◽  
Nadia Howlader ◽  
Edward Lloyd Trimble ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Black Women ◽  
White Women ◽  
Cohort Analysis ◽  
Stage Iv ◽  
Stage Iii ◽  
Teaching Hospitals ◽  
Risk Of Death ◽  
Guideline Care ◽  
Black Patients

e18081 Background: Receipt of guideline care improves survival for women with ovarian cancer yet care may vary by race. We assessed the receipt of guideline care and cancer deaths by race for women with incident ovarian cancer. Methods: This retrospective cohort analysis used the National Cancer Institute’s Patterns of Care data for black and white women diagnosed with all stages of ovarian cancer in 2002 and 2011 (n = 5356) with follow-up through 12/31/14. Data included patient characteristics, type of surgery and chemotherapy, and provider factors. Multivariate logistic regression was used to create the standardized percentages (predictive margins) of women receiving guideline treatment by race group. Cox proportional hazards models were used to assess the unadjusted and adjusted risk of ovarian cancer death by race. Results: At diagnosis, for black women, 35.6% had Stage III and 37.2% had Stage IV disease compared with 44.1% Stage III and 24.2% Stage IV for white women. More black women had surgery in large teaching hospitals (47.6%) than white women (39.7%) but use of gynecologic oncologists (GO) was similar for black women and white women- (62.1% vs 58.8%). In regression models, the standardized percent of black women receiving guideline care was significantly lower than for white women (29.2% vs 38.5%). The unadjusted hazards ratio (HR) for death was significantly higher in black women (HR = 1.32) yet after controlling for patient and provider factors and receipt of guideline care, black women did not have a significantly higher risk of death (HR = 1.08). Conclusions: Rates of guideline care are very low for all women with ovarian cancer, significantly more so for black patients. Low use of guideline care among black women cannot be explained by provider factors as a large percent of black women consulted a GO or received care in large teaching hospitals. Research is needed to address how to increase guideline care among black patients as we found that race was not associated with the risk of death when guideline care was included as a factor in multivariate survival models.

Racial disparities in obesity and comorbidities among women with early breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19061-e19061
Author(s):  
Kirsten A. Nyrop ◽  
Allison Mary Deal ◽  
Hyman B. Muss ◽  
Emily Damone ◽  
Michael Lorentsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Early Breast Cancer ◽  
White Women ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Black And White ◽  
Black Patients ◽  
Potential Impact ◽  
White Patients

e19061 Background: Both comorbidities and obesity (body mass index/BMI 30 or higher) are observed in women at the time of early breast cancer (EBC) diagnosis. This study investigates age and obesity and their association with disparities in comorbidities between black and white women at EBC diagnosis. Methods: This is a retrospective chart review of women with EBC (Stage I-III) treated at a single institution. Relative risk (RR) with 95% Confidence Interval (CI) for individual comorbidities are calculated for black compared to white patients, adjusted for age and BMI. Results: In a sample of 548 women, 26% are black and 74% are white. 18% of black patients vs 28% of white patients were age 65 or older (p = .01). 62% of black vs 33% of white patients had obesity (p < .0001). 63% of black vs 47% of white patients had 2 or more total comorbidities at diagnosis (p = .003). 33% of black vs 10% of white patients had 2 or more obesity-related comorbidities (p < .0001). 60% of black vs 32% of white patients had hypertension (p < .0001); 23% of black vs 6% of white patients had diabetes (p < .0001); and 28% of black vs 18% of white patients had high cholesterol (p = .02). In multivariable (MV) analysis adjusted for age and BMI, black women had 45% higher risk for hypertension [RR 1.45 (1.19-1.75), p = .0002)] and 44% higher risk for diabetes [RR 1.44 (1.02-5.86), p < .0001)] at EBC diagnosis. However, after adjustment, differences by race were no longer seen for > = 2 total comorbidities, > = 2 obesity-related comorbidities, heart disease, or thyroid disease. Conclusions: This study documents significant disparities between black and white women with EBC with regard to high rates of obesity, overall comorbidities and obesity-related comorbidities. Future research should assess the potential impact of weight management (avoiding weight gain) interventions in the first 2 years post diagnosis on improving OS and BCSS among patients with obesity and in reducing OS and BCSS disparities between black and white women.

scholarly journals Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

2021 ◽  
Author(s):  
Matthew J. Czarny ◽  
Rani K. Hasan ◽  
Wendy S. Post ◽  
Matthews Chacko ◽  
Stefano Schena ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Black Race ◽  
Transcatheter Aortic Valve ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P <0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P <0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P =0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P <0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P <0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P =0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.

Impact of equal access healthcare on race disparities in bladder cancer.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 399-399
Author(s):  
Nikhil V. Kotha ◽  
Abhishek Kumar ◽  
Edmund M. Qiao ◽  
Daniel R. Cherry ◽  
Vinit Nalawade ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Healthcare System ◽  
Equal Access ◽  
Disease Stage ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Black Patients ◽  
Black Veterans ◽  
Multivariable Models ◽  
White Patients

399 Background: Outcomes in bladder cancer are disproportionately worse for black patients compared to white patients. We hypothesize these disparities arise in part due to differences in access to healthcare and therefore may be mitigated in an equal access healthcare system, such as the Veterans Affairs’ (VA) system. Here, we examine outcomes by race for patients with bladder cancer within the VA system and then compare these outcomes to those in the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We performed a retrospective cohort study using VA Informatics and Computing Infrastructure (VINCI) and SEER. We included all patients diagnosed with bladder cancer, American Joint Committee on Cancer (AJCC) stage 0-4 diagnosed between 2000 and 2018. Endpoints of overall survival (OS), bladder cancer-specific survival (BCS), and non-bladder cancer-specific survival (NCS) were evaluated in multivariable Cox and Fine-Gray models. Results: Using the VA dataset, we identified 36322 veterans (9.0% black, 91.0% white) with bladder cancer. Black veterans were more likely to have more comorbidities, reside in zip codes with lower median income and education levels, and present with higher stage disease (AJCC stages 2-4) than white veterans (23.3% vs 19%). In multivariable models accounting for disease stage among other covariables, there were no statistically significant differences in any survival endpoint (Table). Using the SEER dataset, we identified 130998 patients (5.9% black, 94.1% white) with bladder cancer. In similar multivariable models, SEER’s black patients had statistically significant inferior outcomes in all survival endpoints compared to SEER’s white patients (Table). Conclusions: While racial disparities for patients with bladder cancer in the SEER database were observed, no differences in survival outcomes between black and white patients were observed in the VA healthcare system. Of note, black veterans presented with more advanced stage, suggesting a delay in diagnosis or a more aggressive cancer phenotype compared to white patients. Our findings underscore the need to bridge healthcare disparities across diverse racial groups. Our study highlights the beneficial impact of an equal access healthcare system in reducing financial and social barriers to healthcare to counteract racial health disparities. Further research is required to delineate these disparities and guide appropriate screening strategies. [Table: see text]

Understanding Disparities in Breast Cancer Care in Memphis, Tennessee

2018 ◽  
Vol 84 (5) ◽  
pp. 620-627 ◽  
Author(s):  
Elena P. Lamb ◽  
F. Elizabeth Pritchard ◽  
Simonne S. Nouer ◽  
Elizabeth A. Tolley ◽  
Brandon S. Boyd ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Cancer Care ◽  
White Women ◽  
Clinical Stage ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Black Patients ◽  
White Patients

Although significant progress has been made in improving breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. The goal of this investigation is to quantify racial disparities in the context of breast cancer care, examining the outcomes of recurrence and mortality in the city of Memphis. Patients with a biopsy-proven diagnosis of breast cancer from January 1, 2002, through December 31, 2012, were obtained from the tumor registry. Black patients were more likely to have advanced (II, III, or IV) clinical stage of breast cancer at diagnosis versus white patients. Black breast cancer patients had a two times higher odds of recurrence (95% confidence interval: 1.4, 3.0) after adjusting for race and clinical stage. Black breast cancer patients were 1.5 times more likely to die (95% confidence interval: 1.2, 1.8), after adjusting for race; age at diagnosis; clinical stage; ER, PR, HER2 status; and recurrence. Black women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery than white women. Black patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus white patients on a citywide level in Memphis. Black breast cancer patients have higher odds of recurrence and mortality when compared with white breast cancer patients, after adjusting for appropriate demographic and clinical attributes. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.

Racial Disparities in Pediatric Acute Myeloid Leukemia during Induction

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 530-530
Author(s):  
Lena E. Winestone ◽  
Kelly Diringer Getz ◽  
Tamara P. Miller ◽  
Jennifer J. Wilkes ◽  
Leah Sack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Public Insurance ◽  
Black Race ◽  
Black Patients ◽  
Publicly Insured ◽  
Insured Patients ◽  
Acute Myeloid ◽  
White Patients

Abstract Introduction: Black patients with acute myeloid leukemia (AML) have inferior overall survival relative to White patients. Few studies have evaluated differences in induction mortality and none has assessed the contribution of severity of illness at presentation to the disparity in survival. Our primary objectives were to compare induction mortality and acuity of presentation among Black relative to White patients and to assess whether any disparity in induction mortality is the consequence of differences in presentation acuity. In addition, we explored the interaction between Black race and public insurance on induction mortality with use of single referent models. Methods: Using a retrospective cohort of children (ages 0 to 18 years) from 2004 to 2014 with new-onset AML diagnosed and treated at free-standing pediatric hospitals who contribute inpatient information to the Pediatric Health Information System administrative database (PHIS), we evaluated inpatient mortality over two courses of standard induction chemotherapy. We examined race (Black versus White) as the primary exposure and insurance was considered with race using a common reference group. We also considered Intensive Care Unit (ICU)-level resource use during the first 72 hours following the initial AML admission as a surrogate for acuity at presentation and a potential mediator of the association between race and induction mortality. Results: 1,122 patients (183 Black, 939 White) with AML who received standard induction chemotherapy were included. Induction mortality for Blacks was substantially higher than for Whites (cHR= 2.31, 95% CI: 1.01, 5.42). Blacks also had a significantly higher risk of requiring any ICU-level care within the first 72 hours after initial presentation compared with Whites (cHR= 1.52, 95% CI: 1.02, 2.24).The association between race and induction mortality was attenuated following adjustment for ICU-level care within the initial 72 hours after admission, (aHR=1.42, 95% CI: 0.67, 2.99). Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Induction mortality rates for Black and White patients were more similar among the privately insured and were increasingly disparate among the publicly insured. Conclusion: Our findings suggest that Black patients with AML present with more acute illness at initial diagnosis, accounting for up to 63% of the relative excess induction mortality. Identifying factors impacting acuity of illness at presentation and associated with public insurance may help to identify opportunities for intervention and thus narrow the current racial disparities in pediatric AML survival. Table 1. Inpatient Induction Mortality and ICU level Care by Race Outcome, Follow-up Period Overall (N=1122) n (%) Black (n=183) n (%) White (n=939) n (%) cHR (95% CI) aHRa (95% CI) Induction Death 27 (2.4%) 8 (4.4%) 19 (2.0%) 2.31 (1.01, 5.42) 1.42 (0.67, 2.99) Any ICU Level Care in first 72 hrs 135 (12.0%) 31 (16.9%) 104 (11.1%) 1.52 (1.04, 2.24) ICU involving >1 system in first 72 hrs 47 (4.2%) 18 (9.8%) 29 (3.1%) 3.35 (1.84, 6.12) Any ICU Level Care in Induction 237 (21.1%) 48 (26.2%) 189 (20.1%) 1.30 (0.99, 1.71) 1.09 (0.74, 1.61) ICU involving >1 system in Induction 99 (8.8%) 22 (12.0%) 77 (8.2%) 1.42 (0.85, 2.38) 0.92 (0.54, 1.57) a adjusted for ICU acuity score within the first 72 hours of index admission Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Disclosures Wilkes: Alex's Lemonade Stand Foundation: Research Funding; Healthcare Research and Quality: Research Funding. Fisher:Merck: Research Funding; Pfizer: Research Funding. Epstein:Medicus Economics: Consultancy. Aplenc:Sigma Tau: Consultancy.

Survival differences by race after minimally invasive versus open radical hysterectomy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6029-6029
Author(s):  
Rebekah Summey ◽  
Jordyn Pike ◽  
Marian Yvette Williams-Brown
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Open Surgery ◽  
White Women ◽  
Tumor Type ◽  
Open Approach ◽  
Hazard Ratios ◽  
Black Patients ◽  
White Patients

6029 Background: Black patients with cervical cancer have historically experienced worse survival compared with white women, as well as decreased rates of minimally invasive surgery (MIS) including radical hysterectomy. The goal of our study is to evaluate if this disparity in survival outcomes reverses in light of new findings favoring an open approach for patients with stage IA2 and IB1 cervical cancer compared to MIS. Methods: The National Cancer Database was queried, and all black and white women with stages IA2 and IB1 cervical cancer who underwent radical hysterectomy from 2010 to 2015 were included. Patients without survival data or documented surgical approach were excluded. Demographic factors were compared using student t-tests and Z-test of proportions as appropriate. Hazard ratios (HR) for the event of mortality were calculated by race and by route of surgery. Kaplan-Meier plots were created to compare survival between groups, and the Cox proportional hazards model was used to adjust for covariates. Results: 4915 patients were identified for inclusion, 12.1% black and 87.9% white. 43.0% of patients underwent open surgery (84.9% white and 15.1% black) and 57.0% underwent MIS (90.1% white and 9.9% black). Average follow up time between groups was 39.5 months for black patients and 40.6 months for white patients. Black patients who underwent open surgery had a hazard ratio (HR) for mortality of 1.44 (95% CI: 1.03-2.00), and those who underwent MIS had a HR of 1.48 (95% CI: 1.03-2.12), when compared to white patients. Mortality rates for black patients undergoing open radical hysterectomy remained higher than those for white patients who underwent MIS. When adjusted for age, insurance status, neighborhood income and educational level, tumor type, Hispanic ethnicity, node positivity and tumor size, these hazard ratios were no longer significant. Conclusions: Following discoveries of improved outcomes following abdominal radical hysterectomy as compared with MIS, we have identified that the discrepancy in ability to undergo MIS did not resolve previously identified disparities in the outcome of death for black women.

scholarly journals Racial Disparities in Recurrence and Overall Survival in Patients With Locoregional Colorectal Cancer

2020 ◽  
Author(s):  
Rebecca A Snyder ◽  
Chung-Yuan Hu ◽  
Syed Nabeel Zafar ◽  
Amanda Francescatti ◽  
George J Chang
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Overall Survival ◽  
Cox Regression ◽  
Statistical Tests ◽  
Risk Of Recurrence ◽  
Black Patients ◽  
Increased Risk ◽  
Study Population ◽  
White Patients

Abstract Background The purpose of this study was to determine the association between race and long-term cancer outcomes (recurrence and overall survival) within a population of US patients with locoregional colorectal cancer (CRC). Methods A cohort study of primary patient data merged with the National Cancer Database as part of a Commission on Cancer Special Study was performed. The study population was a random sample of patients undergoing surgery for stage I to III CRC between years 2006 and 2007 with 5 years of follow-up. Propensity-weighted multivariable Cox regression was performed with pooled results to yield statistical inferences. Prespecified sensitivity analysis was performed only for patients who received guideline concordant care (GCC) of primary CRC. All statistical tests were 2-sided. Results The study population included 8176 patients, 9.9% (n = 811) Black and 90.1% (n = 7365) White. Black patients were more likely to be uninsured or underinsured, have lower household income, and lower educational status (all P &lt; .001). Rates of GCC were higher among Black vs White patients with colon cancer (76.9% vs 72.6%, P = .02), and Black and White patients with rectal cancer were treated with radiation at similar rates (69.1% vs 66.6%, P = .64). Black race was independently associated with increased risk of recurrence (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.26 to 1.73) and mortality (HR = 1.37, 95% CI = 1.18 to 1.59). In sensitivity analysis of only patients who received GCC, observed effects for recurrence (HR = 1.51, 95% CI = 1.27 to 1.79) and overall survival (HR = 1.40, 95% CI = 1.18 to 1.66) persisted. Conclusions Despite higher rates of GCC for CRC, Black patients experience a higher risk of recurrence and mortality compared with White patients.

Survival disparity and racial differences in the use of neoadjuvant chemotherapy (NAC) compared with primary debulking surgery (PDS) in women with ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17099-e17099
Author(s):  
Eirwen M Miller ◽  
Joan Tymon-Rosario ◽  
Xianhong Xie ◽  
Harriet Olivia Smith ◽  
Gary L. Goldberg ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Racial Differences ◽  
Survival Data ◽  
Racial Disparity ◽  
Stage Iv ◽  
Stage Iii ◽  
Disease Stage ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Black Patients

e17099 Background: Studies demonstrate racial disparity in ovarian cancer survival though survival differences seem to be mitigated when patients receive similar care. We sought to identify whether racial disparity exists in the use of NAC or PDS for women with ovarian cancer. Methods: After IRB approval, all patients with epithelial ovarian cancer who received primary treatment at our institution from 2005-2016 were identified from our tumor registry. Charts were retrospectively reviewed for clinicopathologic and survival data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Kaplan-Meier was used to compare survival probabilities. Results: 302 evaluable patients were identified. 240 (79%) patients underwent PDS and 62 (21%) received NAC. Older patients, black patients, and those with stage III/IV disease were more likely to receive NAC. In a multivariate analysis controlling for stage and age, black race remained associated with NAC [OR 3.25 (95% CI 1.41-7.47), p < 0.01]. In a subgroup of advanced disease, stage III patients (n = 138) were more likely than stage IV patients (n = 52) to undergo PDS (78% v 44%, p < 0.01) and black patients were more likely than others to present with stage IV disease (39% v 22%, p = 0.01). NAC was utilized more frequently (48% v 24%, p < 0.01) in black patients compared with all other races. In the advanced stage subgroup analysis, patients that underwent PDS had a longer PFS than those that received NAC [HR 2.21 (95% CI 1.26-3.89), p = 0.01]. Conclusions: Racial disparity exists in the selection of PDS compared with NAC for patients with ovarian cancer and this disparity persists when controlling for stage and age. The choice of NAC or PDS may result in survival disparity. Further investigation is needed to examine other reasons, such as medical co-morbidities and disease distribution, for racial disparity in management. [Table: see text]

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