Abstract PO-113: Overall survival in ovarian cancer patients seeking care at more than one treatment facility

Abstract

Abstract Purpose: Ovarian cancer is the most lethal gynecological cancer and despite advances in treatment, most patients are diagnosed at an advanced stage with poor prognosis. Black women have a lower 5 year survival than White women when diagnosed at the same stage, and while there are a number of contributing factors, quality of treatment center may play a significant role. Choice in treatment facility may be limited by insurance coverage, availability of high-volume hospitals or specialists, or ability to access high-quality facilities, and it is unclear how a change in treatment facility may impact ovarian cancer survival. Methods: Participant usage files from the National Cancer Database were used to interrogate the characteristics of patients that seek treatment at more than one Commission on Cancer accredited facility in the United States to determine the effect on overall survival. Multivariable Cox regression analysis models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) to determine risk of mortality for patients receiving all of their first course treatment at one facility vs those receiving first course treatment at more than one facility. The fully-adjusted model was then stratified by race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic) and by facility type (Community, Comprehensive Community, Academic/Research, Integrative Network). Results: A total of 211,937 women were included in the analysis. Patients were more likely to receive all of their first course treatment at one facility (81%). Patents treated at more than one facility had a 26% increase in ovarian cancer mortality compared with those treated at a single facility (HR: 1.26, 95% CI: 1.24-1.28). When stratified by race, NH-Black patients had the lowest increase in overall survival (HR: 1.08, 95% CI: 1.03-1.14) when compared with NH-White (HR: 1.27, 95% CI: 1.25-1.29) and Hispanic (HR: 1.33, 95% CI: 1.28-1.39) patients. Stratification by facility type showed that among women receiving treatment at more than one facility, those switching to an academic research center had the highest mortality (HR: 1.31, 95% CI: 1.28-1.34). Conclusions: Ovarian cancer patients that received treatment at more than one facility had a higher rate of mortality than those who were treated at a single center. Our findings suggest the need for further investigation into the effects of continuity of care, including how race, facility type, and other socioeconomic factors may modulate those effects. Citation Format: April Deveaux, Jessica Islam, Tomi Akinyemiju. Overall survival in ovarian cancer patients seeking care at more than one treatment facility [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-113.