Journal
GYNECOLOGIC ONCOLOGY
Volume 135, Issue 2, Pages 285-291Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ygyno.2014.08.029
Keywords
Ovarian cancer; Treatment; Racial disparities; Neighborhood socioeconomic status; Comorbidities
Categories
Funding
- NIH/NCMHD [P60 MD003424]
- American Cancer Society [RSG-13-380-01-CPHPS]
- NIH/NCI [2P50CA106743-06]
- NATIONAL CANCER INSTITUTE [P50CA106743] Funding Source: NIH RePORTER
- National Institute on Minority Health and Health Disparities [P60MD003424] Funding Source: NIH RePORTER
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Background. Less than half of women with ovarian cancer and blacks specifically receive therapy adherent to National Comprehensive Cancer Network (NCCN) guidelines. The purpose is to assess the effect of neighborhood-level socioeconomic status (SES) on black-white treatment differences in a population-based analysis in a highly-segregated community. Methods. Illinois State Cancer Registry data for invasive epithelial ovarian cancer cases diagnosed in Cook County, IL in non-Hispanic white (NHW) or black (NHB) women from 1998 to 2009 was analyzed. As few women receive NCCN-adherent care, variables were constructed to assess extent of treatment, including receipt of: 1) debulking surgery; 2) any surgery; 3) multi-agent chemotherapy; and 4) any chemotherapy. Two measures (concentrated affluence and disadvantage) were used to estimate neighborhood-level SES. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (95% Cl), with generalized linear mixed models to account for hierarchical data. Results. 2766 (81.0%) NHW and 647 (19.0%) NHB women were diagnosed. Adjusting for covariates, NHB were less likely to receive debulking surgery (OR: 039; 95% CI: 030-0.50), any surgery.(OR: 038; 95% CI: 0.29-0.49), multi-agent chemotherapy (OR: 0.56; 95% CI: 0.45-0.71) and any chemotherapy (OR: 0.58; 95% CI: 0.45-0.74). Concentrated affluence but not disadvantage was significant in final models for multi-agent and any chemotherapy, but not debulking or any surgery. Conclusions. Results identify black-white differences consistent across treatments that persist despite adjustment for neighborhood-level SES. Impact. Results advance inequality awareness beyond ideal NCCN-adherent care, indicating inequality exists in delivery of even the most basic oncologic care. (C) 2014 Elsevier Inc. All rights reserved.
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