TY - JOUR
T1 - Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status
AU - Bristow, Robert E.
AU - Chang, Jenny
AU - Ziogas, Argyrios
AU - Anton-Culver, Hoda
AU - Vieira, Veronica M.
N1 - Funding Information:
Dr. Bristow was supported in part by an unrestricted research grant from the Queen of Hearts Foundation . This work was supported by the Superfund Research Program (NIEHS 2P42ES007381-17). The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.
PY - 2014/7
Y1 - 2014/7
N2 - Objective To determine the impact of geographic location on advanced-stage ovarian cancer care adherence to the National Comprehensive Cancer Network (NCCN) guidelines in relation to race and socioeconomic status (SES). Methods Patients diagnosed with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Generalized additive models were created to assess the effect of spatial distributions of geographic location, proximity to a high-volume hospital (≥ 20 cases/year), distance traveled to receive care, race, and SES on adherence to NCCN guidelines, with simultaneous smoothing of geographic location and adjustment for confounding variables. Disparities in geographic predictors of treatment adherence were analyzed with the x2 test for equality of proportions. Results Of the 11,770 patients identified, 45.4% were treated according to NCCN guidelines. Black race (OR = 1.49, 95%CI = 1.21-1.83), low-SES (OR = 1.46, 95%CI = 1.24-1.72), and geographic location ≥ 80 km/50 mi from a high-volume hospital (OR = 1.88, 95%CI = 1.61-2.19) were independently associated with an increased risk of non-adherent care, while high-volume hospital treatment (OR = 0.59, 95%CI = 0.53-0.66) and travel distance to receive care ≥ 32 km/20 mi (OR = 0.80, 95%CI = 0.69-0.92) were independently protective. SES was inversely associated with location ≥ 80 km/50 mi from a high-volume hospital, ranging from 6.3% (high-SES) to 33.0% (low-SES) (p < 0.0001). White patients were significantly more likely to travel ≥ 32 km/20 mi to receive care (21.8%) compared to Blacks (14.4%), Hispanics (15.9%), and Asian/Pacific Islanders (15.5%) (p < 0.0001). Conclusion Geographic proximity to a high-volume hospital and travel distance to receive treatment are independently associated with NCCN guideline adherent care for advanced-stage ovarian cancer. Geographic barriers to standard ovarian cancer treatment disproportionately affect racial minorities and women of low-SES.
AB - Objective To determine the impact of geographic location on advanced-stage ovarian cancer care adherence to the National Comprehensive Cancer Network (NCCN) guidelines in relation to race and socioeconomic status (SES). Methods Patients diagnosed with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Generalized additive models were created to assess the effect of spatial distributions of geographic location, proximity to a high-volume hospital (≥ 20 cases/year), distance traveled to receive care, race, and SES on adherence to NCCN guidelines, with simultaneous smoothing of geographic location and adjustment for confounding variables. Disparities in geographic predictors of treatment adherence were analyzed with the x2 test for equality of proportions. Results Of the 11,770 patients identified, 45.4% were treated according to NCCN guidelines. Black race (OR = 1.49, 95%CI = 1.21-1.83), low-SES (OR = 1.46, 95%CI = 1.24-1.72), and geographic location ≥ 80 km/50 mi from a high-volume hospital (OR = 1.88, 95%CI = 1.61-2.19) were independently associated with an increased risk of non-adherent care, while high-volume hospital treatment (OR = 0.59, 95%CI = 0.53-0.66) and travel distance to receive care ≥ 32 km/20 mi (OR = 0.80, 95%CI = 0.69-0.92) were independently protective. SES was inversely associated with location ≥ 80 km/50 mi from a high-volume hospital, ranging from 6.3% (high-SES) to 33.0% (low-SES) (p < 0.0001). White patients were significantly more likely to travel ≥ 32 km/20 mi to receive care (21.8%) compared to Blacks (14.4%), Hispanics (15.9%), and Asian/Pacific Islanders (15.5%) (p < 0.0001). Conclusion Geographic proximity to a high-volume hospital and travel distance to receive treatment are independently associated with NCCN guideline adherent care for advanced-stage ovarian cancer. Geographic barriers to standard ovarian cancer treatment disproportionately affect racial minorities and women of low-SES.
KW - Geographic location
KW - Ovarian cancer
KW - Treatment guidelines
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U2 - 10.1016/j.ygyno.2014.03.561
DO - 10.1016/j.ygyno.2014.03.561
M3 - Article
C2 - 24680770
AN - SCOPUS:84903188204
SN - 0090-8258
VL - 134
SP - 60
EP - 67
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 1
ER -