Conclusions: Race Matters: Disparities in the use of maintenance therapy in ovarian cancer (OC) (061)

Abstract

Objectives: To determine the impact of race, insurance status, and median income on the uptake of maintenance therapy after primary or secondary chemotherapy in platinum responsive platinum-sensitive ovarian cancer (OC). Methods: This IRB-approved study evaluated the association of race, income, and insurance status with the use of maintenance therapy in the primary or platinum-sensitive recurrent setting. All patients were identified who were eligible for maintenance therapy from January 1, 2015, to December 31, 2019. Logistic regression models were used to investigate the association between the use of maintenance therapy and race, insurance status, and census tract median household income as determined by linking geocoded addresses to census data. Results: A total of 180 patients were identified who met the study criteria. Of these patients, 71 were treated with maintenance therapy (19% primary, 41% either). The most common treatments included PARPi in 46%, Bev in 41%, and both in 13%. Insurance status was commercial in 28%, public in 63%, and self-pay in 9%. The use of maintenance therapy was higher with commercial insurance than public or no insurance (26% vs 17% vs 12%), but this was not statistically significant (p=0.44). Patients receiving maintenance therapy lived in areas with slightly higher median household income, but this was not statistically significant ($71,828 vs $64,881; p=0.077). However, fewer black patients received maintenance therapy in either setting (20% vs 41%; p=0.034). Similarly, fewer Black patients received maintenance therapy in the primary setting (4% vs 21%: p = 0.040). In a multivariable regression model, race, census tract median income, and insurance status were not significantly associated with receiving maintenance therapy. Black patients were less likely to receive maintenance therapy in the multivariable model, although this did not reach significance (OR: 0.33; 95% CI: 0.10-1.08, p=0.08). Black patients are less likely to be treated with maintenance therapy after responding to platinum-based chemotherapy. This difference is not explained by insurance status or household income. It is important to understand why racial differences persist in healthcare delivery to optimize outcomes for all patients. Objectives: To determine the impact of race, insurance status, and median income on the uptake of maintenance therapy after primary or secondary chemotherapy in platinum responsive platinum-sensitive ovarian cancer (OC). Methods: This IRB-approved study evaluated the association of race, income, and insurance status with the use of maintenance therapy in the primary or platinum-sensitive recurrent setting. All patients were identified who were eligible for maintenance therapy from January 1, 2015, to December 31, 2019. Logistic regression models were used to investigate the association between the use of maintenance therapy and race, insurance status, and census tract median household income as determined by linking geocoded addresses to census data. Results: A total of 180 patients were identified who met the study criteria. Of these patients, 71 were treated with maintenance therapy (19% primary, 41% either). The most common treatments included PARPi in 46%, Bev in 41%, and both in 13%. Insurance status was commercial in 28%, public in 63%, and self-pay in 9%. The use of maintenance therapy was higher with commercial insurance than public or no insurance (26% vs 17% vs 12%), but this was not statistically significant (p=0.44). Patients receiving maintenance therapy lived in areas with slightly higher median household income, but this was not statistically significant ($71,828 vs $64,881; p=0.077). However, fewer black patients received maintenance therapy in either setting (20% vs 41%; p=0.034). Similarly, fewer Black patients received maintenance therapy in the primary setting (4% vs 21%: p = 0.040). In a multivariable regression model, race, census tract median income, and insurance status were not significantly associated with receiving maintenance therapy. Black patients were less likely to receive maintenance therapy in the multivariable model, although this did not reach significance (OR: 0.33; 95% CI: 0.10-1.08, p=0.08). Black patients are less likely to be treated with maintenance therapy after responding to platinum-based chemotherapy. This difference is not explained by insurance status or household income. It is important to understand why racial differences persist in healthcare delivery to optimize outcomes for all patients.