Abstract
BackgroundIn contrast to most other forms of cancer, data from some developing and developed countries show surprisingly similar survival rates for ovarian cancer. We aimed to compare ovarian cancer survival in Philippine residents, Filipino-Americans and Caucasians living in the US, using a high resolution approach, taking potential differences in prognostic factors into account.MethodsUsing databases from the SEER 13 and from the Manila and Rizal Cancer Registries, age-adjusted five-year absolute and relative survival estimates were computed using the period analysis method and compared between Filipino-American ovarian cancer patients with cancer patients from the Philippines and Caucasians in the US. Cox proportional hazards modelling was used to determine factors affecting survival differences.ResultsDespite more favorable distribution of age and cancer morphology and similar stage distribution, 5-year absolute and relative survival were lower in Philippine residents (Absolute survival, AS, 44%, Standard Error, SE, 2.9 and Relative survival, RS, 49.7%, SE, 3.7) than in Filipino-Americans (AS, 51.3%, SE, 3.1 and RS, 54.1%, SE, 3.4). After adjustment for these and additional covariates, strong excess risk of death for Philippine residents was found (Relative Risk, RR, 2.45, 95% confidence interval, 95% CI, 1.99-3.01). In contrast, no significant differences were found between Filipino-Americans and Caucasians living in the US.ConclusionMultivariate analyses disclosed strong survival disadvantages of Philippine residents compared to Filipino-American patients, for which differences in access to health care might have played an important role. Survival is no worse among Filipino-Americans than among Caucasians living in the US.
Highlights
In contrast to most other forms of cancer, data from some developing and developed countries show surprisingly similar survival rates for ovarian cancer
We take a "high resolution" approach [8,9,10] to elucidate the role of factors not routinely available in population-based cancer registries, including ethnicity, stage at diagnosis, morphology, and access to treatment, in comparing ovarian cancer survival between Philippine resident patients, Filipino-Americans and Caucasians living in the US
A total of 463 Filipino-American and 22,290 Caucasian ovarian cancer patients were included in the analysis, after exclusion of around 1% of cases who are coded in situ and those who were identified by death certificates only (DCO)
Summary
In contrast to most other forms of cancer, data from some developing and developed countries show surprisingly similar survival rates for ovarian cancer. We aimed to compare ovarian cancer survival in Philippine residents, Filipino-Americans and Caucasians living in the US, using a high resolution approach, taking potential differences in prognostic factors into account. Ovarian cancer incidence and mortality have likewise been reported to vary between racial groups. The incidence rate of Philippine residents in 2002 was estimated at 11.5 per 100,000 [3] as compared to 10.3 for Caucasians and 8.9 for Asian and Pacific Islanders (API) in the United States [4]. Mortality rates were reported as 6.3 [3], 6 and 3.3 [4] per 100,000 for Philippine residents, Caucasians and APIs, respectively
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