Racial disparities in ovarian cancer surgical care: A population-based analysis

Objective: To investigate differences according to racial classification in the frequency of ovarian cancer-related surgical procedures and in access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer. Methods: The Maryland Health Services Cost Review Commission database was accessed for women age > 18 years undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 7/1/01 and 6/30/09. Multivariate logistic regression analyses were used to evaluate for differences in the likelihood of selected surgical procedures and access to high-volume surgical providers (surgeons ≥ 10 cases/year; hospitals ≥ 20 case/year) according racial classification. Results: A total of 2487 patients were identified who underwent a primary surgical procedure that included oophorectomy for a malignant ovarian neoplasm: White = 1884 (75.4%), African-American = 400 (16.1%), and other/unknown = 203 (8.2%). Compared to White patients, African-American patients were significantly younger (mean age 55.4 years vs 59.9 years, P < 0.0001) and less likely to have commercial insurance (28.5% vs 39.5%, p < 0.0001). Compared to White patients, African-American racial classification was associated with a statistically significant and independent lower likelihood of hysterectomy (OR = 0.53, 95%CI = 0.42-0.66, p < 0.0001), colon resection (OR = 0.65, 95%CI = 0.48-0.87, p = 0.004), lymphadenectomy (OR = 0.67, 95%CI = 0.50-0.91, p = 0.01), and surgery by a high-volume surgeon (OR = 0.55, 95%CI = 0.44-0.69, p < 0.0001). Conclusions: Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.