What factors determine the level of care provided to women diagnosed with ovarian cancer? And how do those standards of care affect patient outcomes – including survival rates?
A study conducted by a multidisciplinary team of investigators from the University of Kentucky aimed to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia. The resulting publication, “Population-Based Analysis of Patient Age and Other Disparities in the Treatment of Ovarian Cancer in Central Appalachia and Kentucky,” appears in the Southern Medical Journal.
Prior research has demonstrated that adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. In this investigation, data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance as well as survival.
Investigators found that in the studied population, most women were aged 65 years or older and had high-grade and advanced-stage ovarian cancer. Overall, two-thirds of cases (65.9 percent) received NCCN-recommended treatment for ovarian cancer, but results from the logistic regression showed that NCCN-compliant treatment was more likely for women aged 65 to 74 years compared with women aged 20 to 49 years, late-stage compared with early-stage cancers, with receipt of care at tertiary care hospitals, and for those patients privately insured versus those with Medicaid or Medicare.
The hazard ratio of death for women who did not receive NCCN-compliant care was 62 percent higher compared with the women who did receive NCCN-compliant treatment. When treatment of ovarian cancer did not follow NCCN recommendations – a more likely situation for patients who were younger, had early-stage disease, did not have private insurance, or had care provided at a non-tertiary care hospital – patients had a significantly higher risk of death.
In Kentucky and Central Appalachia – areas with a disproportionately high burden of cancer morbidity and mortality – this new information emphasizes the need for clinicians and health professionals at all institutions to work together to ensure a high standard of care for all populations.
The study team included clinicians and researchers from the following University of Kentucky departments: the College of Medicine department of obstetrics and gynecology, the Biostatistics and Bioinformatics Shared Resource Facility, the division of gynecologic oncology, the Markey Cancer Center, and the departments of biostatistics and epidemiology in the College of Public Health.