Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study

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  • 1 Duke University School of Medicine,
  • | 2 Department of Population Health Sciences, Duke University School of Medicine, and
  • | 3 Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina;
  • | 4 Department of Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington, Kentucky;
  • | 5 Division of Preventive Medicine, and
  • | 6 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama;
  • | 7 Georgia Cancer Registry, Emory University, Atlanta, Georgia;
  • | 8 New York State Cancer Registry, New York State Department of Health, Albany, New York; and
  • | 9 Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.

Background: Racial disparities exist in receipt of guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities. Methods: We analyzed data from non-Hispanic (NH)–Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of guideline-concordant OC surgery and chemotherapy was defined based on the NCCN Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA. Results: The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01–1.08) and availability (RR, 1.06; 95% CI, 1.02–1.10) were associated with receipt of guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05–1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75–0.99). Conclusions: Multiple HCA dimensions predict receipt of guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.

Submitted March 5, 2022; final revision received July 14, 2022; accepted for publication July 14, 2022.

Author contributions: Conceptualization: Akinyemiju. Statistical analysis: Wilson. Data compilation: Wilson. Writing—original draft: All authors. Writing—review and editing: Previs, Gupta, Joshi, Huang, Pisu, Liang, Ward, Schymura, Berchuck, Akinyemiju.

Data availability statement: Data may be requested by applying to the SEER-Medicare program.

Disclosures: Dr. Wilson has disclosed receiving grant/research support from AstraZeneca. Dr. Previs has disclosed serving on an advisory board for Myriad Genetics and Natera. The remaining 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.

Funding: Research reported in this publication was supported by the NCI of the NIH under award number R37CA233777 (T.F. Akinyemiju) and by the NIH under award number K12 HD103083 (R.A. Previs).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Tomi F. Akinyemiju, PhD, Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27708. Email: tomi.akinyemiju@duke.edu

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