Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients

• Published in: Gynecologic oncology 2021-02, Vol.160 (2), p.477-484
• Main Authors: Weeks, Kristin, Lynch, Charles F., West, Michele, Carnahan, Ryan, O'Rorke, Michael, Oleson, Jacob, McDonald, Megan, Stewart, Sherri L., Charlton, Mary
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cytoreduction Surgical Procedures - statistics & numerical data; Female; Gynecology - organization & administration; Gynecology - statistics & numerical data; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Humans; Iowa; Kansas; Medical Oncology - organization & administration; Medical Oncology - statistics & numerical data; Middle Aged; Missouri; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - surgery; Ovariectomy - statistics & numerical data; Referral and Consultation - organization & administration; Referral and Consultation - statistics & numerical data; Retrospective Studies; Rural Health Services - organization & administration; Rural Health Services - statistics & numerical data; Rural Population - statistics & numerical data; Travel - statistics & numerical data; Urban Health Services - organization & administration; Urban Health Services - statistics & numerical data; Urban Population - statistics & numerical data; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2020.11.006

Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18–89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010–2012 in Kansas, Missouri and Iowa by rurality. Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24–0.58) and referral to a specialist (OR 0.37, 95% CI 0.23–0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26–1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm. There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them. •Rural ovarian cancer patients are 63% less likely to receive a referral to a gynecologic oncologist for surgery•Rural ovarian cancer patients are significantly less likely to receive surgery from a gynecologic oncologist•After a surgical referral, rural ovarian cancer patients are just as likely to receive surgery from a specialist•Specialist-provided surgery increases receipt of cytoreduction and complete tumor removal for rural ovarian cancer patients•Rural women (versus urban) who receive surgery from a gynecologic oncologist travel farther to surgical care