Background: More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. Patients and Methods: Women diagnosed with all stages of epithelial OC (1996–2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. Results: Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45–2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07–1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70–0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. Conclusions: Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.
Submitted January 7, 2019; accepted for publication June 3, 2019.Author contributions:Study concept and design: Bristow, Vieira. Data acquisition and assembly: Chang, Ziogas. Data analysis: Villanueva. Technical support: Bartell, Vieira. Interpretation of results: All authors. Manuscript preparation: Villanueva, Vieira. Final manuscript review and approval: All authors.Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article. This research was supported by funding from the National Center on Minority Health and Health Disparities (R01MD009697).Correspondence: Carolina Villanueva, MPH, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, 2040C Anteater Instruction and Research Building, Irvine, CA 92697. Email: email@example.com
BristowRE, ChangJ, ZiogasA, . Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status. Gynecol Oncol 2014;134:60–67.2468077010.1016/j.ygyno.2014.03.561)| false
BristowRE, ChangJ, ZiogasA, . Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines. Obstet Gynecol 2015;125:833–842.10.1097/AOG.000000000000064325751200)| false
HodeibM, ChangJ, LiuF, . Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer. Gynecol Oncol 2015;138:121–127.10.1016/j.ygyno.2015.04.01125913132)| false
CollinsY, HolcombK, Chapman-DavisE, . Gynecologic cancer disparities: a report from the Health Disparities Taskforce of the Society of Gynecologic Oncology. Gynecol Oncol 2014;133:353–361.2440629110.1016/j.ygyno.2013.12.039)| false
CroninKA, HowladerN, StevensJL, . Racial disparities in the receipt of guideline care and cancer deaths for women with ovarian cancer. Cancer Epidemiol Biomarkers Prev 2019;28:539–545.10.1158/1055-9965.EPI-18-028530487136)| false
BristowRE, PowellMA, Al-HammadiN, . Disparities in ovarian cancer care quality and survival according to race and socioeconomic status. J Natl Cancer Inst 2013;105:823–832.2353975510.1093/jnci/djt065)| false
Long B, Chang J, Ziogas A, . Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California. Am J Obstet Gynecol 2015;212:468.e1–468.e9.
LongB, ChangJ, ZiogasA, . Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California. Am J Obstet Gynecol 2015;212:468.e1–468.e9.10.1016/j.ajog.2014.10.1104)| false
FairfieldKM, LucasFL, EarleCC, . Regional variation in cancer-directed surgery and mortality among women with epithelial ovarian cancer in the Medicare population. Cancer 2010;116:4840–4848.10.1002/cncr.2524220578182)| false
Tracey E, Hacker NF, Young J, . Effects of access to and treatment in specialist facilities on survival from epithelial ovarian cancer in Australian women: a data linkage study. Int J Gynecol Cancer 2014;24:1232–1240.
TraceyE, HackerNF, YoungJ, . Effects of access to and treatment in specialist facilities on survival from epithelial ovarian cancer in Australian women: a data linkage study. Int J Gynecol Cancer 2014;24:1232–1240.10.1097/IGC.000000000000021325153678)| false
Galvan-TurnerVB, ChangJ, ZiogasA, . Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer. Gynecol Oncol 2015;139:495–499.10.1016/j.ygyno.2015.09.01526387962)| false
BristowRE, ZahurakML, Diaz-MontesTP, . Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes. Gynecol Oncol 2009;115:334–338.1976629510.1016/j.ygyno.2009.08.025)| false
PolskyD, ArmstrongKA, RandallTC, . Variations in chemotherapy utilization in ovarian cancer: the relative contribution of geography. Health Serv Res 2006;41:2201–2218.10.1111/j.1475-6773.2006.00596.x17116116)| false
Chase DM, Fedewa S, Chou TS, . Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy? Obstet Gynecol 2012;119:68–77.
ChaseDM, FedewaS, ChouTS, . Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy? Obstet Gynecol 2012;119:68–77.10.1097/AOG.0b013e31823d400622183213)| false
American Cancer Society. Cancer Statistics Center. Ovary. Available at: https://cancerstatisticscenter.cancer.org/?_ga=2.71867859.1377176935.1542797564-800158735.1542797564#!/cancer-site/Ovary. Accessed October 2, 2019.)| false
YostK, PerkinsC, CohenR, . Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 2001;12:703–711.1156211010.1023/A:1011240019516)| false
WebsterT, VieiraV, WeinbergJ, . Method for mapping population-based case-control studies: an application using generalized additive models. Int J Health Geogr 2006;5:26.10.1186/1476-072X-5-2616764727)| false
Erickson BK, Martin JY, Shah MM, . Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center. Gynecol Oncol 2014;133:142–146.
EricksonBK, MartinJY, ShahMM, . Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center. Gynecol Oncol 2014;133:142–146.10.1016/j.ygyno.2014.02.00624517876)| false
Pfaendler KS, Chang J, Ziogas A, . Disparities in adherence to National Comprehensive Cancer Network treatment guidelines and survival for stage IB-IIA cervical cancer in California. Obstet Gynecol 2018;131:899–908.
PfaendlerKS, ChangJ, ZiogasA, . Disparities in adherence to National Comprehensive Cancer Network treatment guidelines and survival for stage IB-IIA cervical cancer in California. Obstet Gynecol 2018;131:899–908.10.1097/AOG.000000000000259129630020)| false
BoulosDN, GhaliRR, IbrahimEM, . An eight-year snapshot of geospatial cancer research (2002-2009): clinico-epidemiological and methodological findings and trends. Med Oncol 2011;28:1145–1162.10.1007/s12032-010-9607-z20589539)| false
Bristow RE, Palis BE, Chi DS, . The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol 2010;118:262–267.
BristowRE, PalisBE, ChiDS, . The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol 2010;118:262–267.2057339210.1016/j.ygyno.2010.05.025)| false
JonesAP, HaynesR, SauerzapfV, . Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. Eur J Cancer 2008;44:992–999.1837511710.1016/j.ejca.2008.02.001)| false