Racial disparities persist in access to ovarian cancer care

Most people with ovarian cancer don’t receive recommended treatments to give them the best possible survival outcomes, and the odds are even lower when patients are black, a new study finds.

Disparities in ovarian cancer treatment have persisted for years, caused in part by issues of access and affordability. But even after taking these factors into account, the new study found that black patients were 14% less likely than white patients to receive all of the treatments recommended for ovarian cancer by the National Comprehensive Cancer Network (NCCN). (PDF).

“While the ability to pay and the number of hospitals and specialists in the area impact a patient’s cancer care, these do not fully explain racial disparities in breast cancer treatment. ovary,” said study lead author Mary Katherine Montes of Oca, MD, of Duke University School. of medicine, said in a statement.

Treatment guidelines for ovarian cancer usually involve a combination of surgery and chemotherapy and vary depending on what is called the stage of the tumor or how advanced and aggressive the cancer is. at diagnosis, according to the American Cancer Society. Staging takes into account the size of tumors and their spread to surrounding organs, lymph nodes, or distant parts of the body.

Most patients first undergo surgery, usually to remove one or both ovaries and fallopian tubes as well as the uterus, depending on the stage of the tumor and whether the patient wishes to have children after treatment. When the cancer is more advanced, patients may also need surgery to remove fatty tissue from the abdomen or to remove pieces of other organs where tumors are found.

Chemotherapy usually comes next, with most patients requiring at least three to six cycles of treatment. When the cancer is more advanced, patients may receive additional treatment with targeted drugs such as bevacizumab (Avastin) after chemotherapy is finished.

To see how often patients received all of these recommended treatments, the researchers looked at data from 5,632 patients diagnosed with ovarian cancer between 2008 and 2015 who survived at least a year after their diagnosis. While the majority of patients in the study were white, 6% were black and 6% Hispanic.

Very few patients received full recommended treatment regimens – only 24% of white and Hispanic patients and only 14% of black patients, researchers reported in the Journal of the National Comprehensive Cancer Network.

When care was more affordable for patients, they were 5% more likely to have the surgery they needed and 9% more likely to start chemotherapy. When access to specialists was easier, patients were also 6% more likely to undergo surgery.

Interestingly, many black patients in the study tended to live closer to urban areas where care was available, while more white patients lived in rural communities without major cancer centers nearby. This suggests that black patients may have difficulty accessing for other reasons such as lack of transportation to get to appointments, the study team wrote.

“For many reasons, including the legacy of structural racism, black patients have more limited access to health care,” said study lead author Tomi Akinyemiju, PhD, of Duke University School of Medicine. Medicine, in a press release.

“This is related to employment patterns, which predict quality insurance coverage and residential patterns, and in turn, the availability and quality of health care resources in predominantly black neighborhoods,” said Dr Akinyemiju. “As a society, we need to have difficult conversations about access to quality care and collectively find solutions so that a diagnosis of cancer does not become a death sentence for the most vulnerable members of our society.”

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