Abstract PO-229: Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients

Abstract

Abstract Objective Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncology specialist despite guideline recommendations. There is a critical need to investigate the contributing barriers. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. Methods We utilized a retrospective cohort created through extension of standard state cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18-89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010-2012 in Kansas, Missouri and Iowa by rurality. As well, factors associated with surgical care were assessed among women living in urban and rural residences at the time of cancer diagnosis. Results Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24-0.58) and referral to a specialist (OR 0.37, 95% CI 0.23-0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26-1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤ 1cm, but experienced a greater time from diagnosis-to-surgery (mean: 19 days versus 9 days, p value 0.022). Conclusion There is a large urban-rural difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the urban-rural difference. Further research is needed into the causes of referral disparities, as well as promising strategies to address them. Citation Format: Kristin S. Weeks, Charles F. Lynch, Michele West, Ryan Carnahan, Michael O'Rorke, Jacob Oleson, Megan McDonald, Sherri L. Stewart, Ovarian Cancer Treatment Study Group, Mary Charlton. Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-229.