Disparities in Ovarian Cancer Survival at the only NCI-designated Cancer Center in Kansas

Abstract

Ovarian cancer is the fifth most deadly cancer among women and the deadliest gynecologic cancer in the United States. Although it is a relatively rare form of cancer, its toll on morbidity and mortality is not equally distributed. In Maryland, women who reside at distance extremes ( 50 miles) to an urban NCI-designated cancer center (NCI-CC) are less likely to complete treatment for gynecologic malignancies. In California, women with low socioeconomic status and those who live more than 50 miles from an NCI-CC are less likely to receive guideline-adherent care and have worse ovarian cancer survival. Our objective was to examine the impact of residential distance and socioeconomic status on survival outcomes for patients receiving treatment for ovarian cancer at a frontier-state NCI-CC. Patients who were treated for ovarian cancer at a single institution from 2010-2015 were identified. Age at diagnosis, insurance status, and distance from the patient’s home to the institution were abstracted. Median income was estimated using 2013 American Census Survey. Clinical data including stage at diagnosis, surgical status, chemotherapy cycles, Charlson comorbidity index, dates of diagnosis, recurrence, and death were obtained. Patients treated at other institutions and those with non-epithelial pathology were excluded. Overall survival (OS) and progression free survival (PFS) were analyzed by Kaplan Meier survival curves and cox proportional hazard models using SAS v9.4. A total of 329 patients were identified, 227 patients completed all care at the institution and 102 patients completed partial care. Among patients who received all their care at the NCI-CC, survival analysis based on distance demonstrated that patients who lived less than 10 miles from the institution had worse survival (p=0.0137). 5-year survival was 37% for patients who lived less than 10 miles from the institution and 57% for those who lived greater than 10 miles away. Lower median income (<$55,268) regardless of distance to institution was also associated with worse survival, p = 0.0210. Among patients who received partial care at the institution, greater than 80% received NCCN guideline adherent care. There was no survival disparity between patients who received all vs partial care at our NCI-CC. Among patients who received all care for ovarian cancer at our institution, stage at diagnosis, presence of comorbidities, lower median income and residential distance less than 10 was associated with worse overall survival. We report high rates of NCCN guideline adherent care regardless of if all vs partial care was received at our institution.