Ovarian cancer treatment in black and white women: A comparison of clinico-pathologic factors and outcome

Abstract

16531 Background: Racial disparities have been identified at all points along the cancer continuum. It is unclear how biology, social determinants, access, and health care systems interact and contribute to disparities. We evaluated patterns of care and outcomes among women with epithelial ovarian cancer treated at a single specialty academic center in order to focus on racial differences in treatment and survival among a group of women who because of the center where they were treated, should all have had equal access to state-of-the art medical care. Our hypothesis was that equal treatment would result in equal outcomes. Methods: Demographic and clinical- pathologic information from the University of Chicago Ovarian Cancer Database from 1992 until the present was analyzed. Continuous variables were analyzed with t tests and categorical variables were analyzed with chi square tests. Differences in survival between the two groups were represented using Kaplan-Meier methods and analyzed using log rank tests. Results: We identified 209 women with invasive ovarian cancer, 163 (78%) white and 46 (22%) black. There was no difference between the groups in terms of age or family history of gynecologic malignancy. Disease stage, histology, grading, preoperative and postoperative CA-125 levels were similar between the racial groups. There was no difference in rates of optimal debulking (<1 cm residual tumor) or platinum sensitivity. Survival analysis displayed no difference in time to recurrence or overall survival between black and white patients. For black women, the median overall survival was 37.2 months (95% Confidence Interval (CI): 22.5, 52.9) while it was 34.1 months (95% CI: 27.4, 42.6) for white women. Conclusions: There is no evidence of a racial difference in either treatment or survival for ovarian cancer patients in our single institution review. Single institution reviews are helpful in pinpointing the origin of racial disparities along the cancer continuum. If equal treatment results in equal outcomes, then sources of disparities must be sought in the unequal distribution and quality of healthcare in the United States. No significant financial relationships to disclose.