Abstract
ObjectiveInvestigate the impact of socioeconomic status and other demographic variables on adherence to the National Comprehensive Cancer Network ovarian cancer treatment guidelines among patients with stage I/II disease. MethodsPatients diagnosed with stage I/II epithelial ovarian cancer between 1/1/96–12/31/06 were identified from the California Cancer Registry. Univariate analysis and multivariate logistic regression models were used to evaluate differences in surgical procedures, chemotherapy regimens, and overall adherence to the NCCN guidelines according to increasing SES quintiles (SES-1 to SES-5). ResultsA total of 5445 stage I and II patients were identified. The median age at diagnosis was 54.0years (range=18–99years); 72.5% of patients had stage I disease, while 27.5% had stage II disease. With a median follow-up time of 5years, the 5-year ovarian cancer-specific survival for all patients was 82.7% (SE=0.6%). Overall, 23.7% of patients received care that was adherent to the NCCN guidelines. Compared to patients in the highest SES quintile (SES-5), patients in the lowest SES quintile (SES-1) were significantly less likely to receive proper surgery (27.3% vs 47.9%, p<0.001) or chemotherapy (42.4% vs 53.6%, p<0.001). There were statistically significant trends between increasing SES and the likelihood of overall treatment plan adherence to the NCCN guidelines: SES-1=16.4%, SES-2=19.0%, SES-3=22.4%, SES-4=24.2% and SES-5=31.6% (p<0.001). Multivariate logistic regression analysis revealed that compared to SES-5, decreasing SES was independently predictive of a higher risk of non-standard overall care. ConclusionsFor patients with early-stage ovarian cancer, low SES is a significant and independent predictor of deviation from the NCCN guidelines for surgery, chemotherapy, and overall treatment.
Highlights
Ovarian cancer remains the most deadly gynecologic cancer in the United States, with approximately 22,000 new cases diagnosed in 2014 and 14,000 related deaths [1]
Multiple improvements have been made in the care of ovarian cancer patients, these improvements have not been distributed among women of all races, income levels and socioeconomic status (SES)
In light of recent research linking adherence to evidencebased guidelines to improved survival for patients with early stage ovarian cancer, the results of this study emphasize the disproportionate burden of substandard care experienced by disadvantaged populations [4]
Summary
Ovarian cancer remains the most deadly gynecologic cancer in the United States, with approximately 22,000 new cases diagnosed in 2014 and 14,000 related deaths [1] This high mortality rate is largely linked to the disproportionate percentage of women diagnosed with advanced stage disease. Evidence-based treatment guidelines for early stage ovarian cancer have been put forth by the National Comprehensive Cancer Network (NCCN) and include comprehensive surgical staging followed by either chemotherapy or surveillance based on surgico-pathologic characteristics. These guidelines have been validated as correlating with improved disease-specific survival and can be considered a process measure of high-quality cancer care [2]
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