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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.
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