Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy

• Published in: Cancer causes & control 2024-03, Vol.35 (3), p.487-496
• Main Authors: Washington, Caretia J., Karanth, Shama D., Wheeler, Meghann, Aduse-Poku, Livingstone, Braithwaite, Dejana, Akinyemiju, Tomi F.
• Format: Article
• Language: English
• Subjects: Asian American Native Hawaiian and Pacific Islander - statistics & numerical data; Biomedical and Life Sciences; Biomedicine; Black or African American - statistics & numerical data; Black people; Cancer; Cancer Research; Carcinoma, Ovarian Epithelial - epidemiology; Carcinoma, Ovarian Epithelial - ethnology; Carcinoma, Ovarian Epithelial - mortality; Carcinoma, Ovarian Epithelial - therapy; Death; Epidemiology; Ethnicity; Ethnicity - statistics & numerical data; Female; Hazard assessment; Hematology; Hispanic or Latino - statistics & numerical data; Humans; Minority & ethnic groups; Mortality; Mortality risk; Oncology; Original Paper; Ovarian cancer; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - ethnology; Ovarian Neoplasms - mortality; Ovarian Neoplasms - therapy; Pacific Islander people; Population studies; Public Health; Race; Risk; Social Determinants of Health - economics; Social Determinants of Health - ethnology; Social Determinants of Health - statistics & numerical data; Socioeconomic Disparities in Health; Socioeconomic factors; Socioeconomics; Statistical models; Subgroups; Survival; Therapy; White people; White People - statistics & numerical data
• ISSN: 0957-5243; 1573-7225
• DOI: 10.1007/s10552-023-01810-y

Purpose The purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy. Methods We analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt. Results The study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03–1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05–1.21). Conclusions Among women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.