Does treatment at a high volume center mitigate racial and ethnic disparities in ovarian cancer survival?

Abstract

5584 Background: Population-based studies of women with advanced ovarian cancer report racial/ethnic disparities in access to high volume centers (HVCs), surgical outcomes after primary debulking surgery (PDS), and overall survival (OS). However, there is evidence that with equal utilization of expert ovarian cancer care, differences in survival dissipate. The objective of this study is to evaluate patients (pts) with advanced ovarian cancer who had PDS at a HVC to determine whether racial/ethnic disparities persist in surgical outcome and survival. Methods: With IRB approval, all pts with stages IIIB to IV high-grade ovarian cancer who underwent PDS from 1/2001-12/2013 were identified. Pts self-identified race/ethnicity as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Asian (A), or Hispanic (H) in the medical record. The main outcome measures were PDS <1cm residual and OS. A Cox proportional hazards model was used to compare OS by race/ethnicity. Pt and clinical factors, including age, income, BRCA status, BMI, ASA, grade, carcinomatosis, bulky abdominal disease, were adjusted for in the multivariate analysis. Results: 963 pts were identified: 851 NHW (88%); 43 A (4%), 34 H (4%), 28 NHB (3%), 7 Other (0.7%). Asian pts were younger at diagnosis (p<0.0001); there were no differences in other demographic or clinical characteristics among racial/ethnic groups. After adjusting for pt and clinical factors, the likelihood of PDS to residual <1cm was similar among NHB and H compared to NHW pts; Asian pts were more likely than NHW to have >1cm residual (OR 2.32, 95%CI 1.1-4.9, p=.03). Median OS was 55.1 mos (95%CI: 51.8-58.5) for the entire cohort. On both univariate and multivariate analysis, there was no disparity in OS among racial or ethnic groups (p=0.615). Conclusions: Racial and ethnic disparities in overall survival and surgical outcomes in women with advanced ovarian cancer can be reduced by treatment at a HVC. Additional research is needed to determine what factors are associated with receiving treatment at HVCs, and what interventions could increase the diversity of patients treated at HVCs.