By ASCO Postal Staff
Published: 11/15/2022 12:08:00
New research examining whether patients with ovarian cancer received care consistent with National Comprehensive Cancer Network (NCCN) clinical practice guidelines for oncology (NCCN guidelines) has found clear disparities based on patient race, ability to pay, and access to specialists and cancer centers—having a significant impact on the course of treatment and affecting survival. The results were published by Montes de Oca in JNCCN–Journal of the National Comprehensive Cancer Network.
Research highlights the importance of guideline-compliant treatment
Researchers used a Surveillance, Epidemiology, and Outcomes–Medicare data set to examine treatment received by patients who had at least 12 months of continuous enrollment in Medicare fee-based service before and after diagnosis. ovarian cancer. The results also referenced previous studies that illustrated poorer outcomes, including increased mortality, for ovarian cancer patients who did not receive guideline-compliant treatment based on the NCCN guidelines recommendations for cycles of surgery and chemotherapy. According to the cited research, guideline-compliant treatment has been associated with significantly improved outcomes for black and white patients, but some racial disparities in survival remain, likely due to later diagnoses or higher comorbidity burdens.
“We know that the best results for [patients with] ovarian cancer are achieved when affected patients are treated according to NCCN guidelines. This study demonstrated, like many other studies, that non-Hispanic black patients [with ovarian cancer] were less likely than non-Hispanic white patients [with ovarian cancer] receive care based on NCCN guidelines,” commented Ronald D. Alvarez, MD, MBA, Betty and Lonnie S. Burnett Professor of Obstetrics and Gynecology, Chairman and Clinical Chief of Obstetrics and Gynecology at Vanderbilt University Medical Center, and Vice Chair of the NCCN Guidelines Expert Panel for the ovarian cancer, who was not involved in the research. “This study specifically highlighted that non-Hispanic black patients were less likely to undergo guideline-based surgery or initiate/complete chemotherapy and that this was primarily related to lower accessibility and availability of cancer services from quality ovary.”
Of the 6,632 cases studied, 23.8% of non-Hispanic white patients received fully compliant surgery and chemotherapy, compared to only 14.2% of non-Hispanic black patients. Racial disparities persisted after adjusting for accessibility to health care, including ability to pay for care and access to local specialists.
“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. More work needs to be done to determine what other factors contribute to these inequalities,” said the study’s lead author. Mary Katherine Montes of Oca, MDresident at Duke University School of Medicine.
“Improving the affordability and availability of these services should help improve adherence to guidelines and improve ovarian cancer outcomes in non-Hispanic black patients. Interestingly, this study suggests that outcomes for this population would still be lower than for non-Hispanic white patients, even if affordability and availability issues were overcome,” Dr. Alvarez noted.
“Difficult conversations” necessary
“The reasons [for this] are complex and multifaceted. For many reasons, including the legacy of structural racism, black patients have more limited access to health care. 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,” he pointed out. lead author of the study. Tomi F. Akinyemiju, PhD, Associate Professor of Population and Global Health; vice chair of diversity and inclusion in the Department of Population Health Sciences; and Associate Director of Community Outreach, Engagement, and Equity at the Duke Cancer Institute at Duke University School of Medicine. “As our study shows, they are important contributors to receiving guideline-compliant care. There is also an aspect of the quality of interactions between patients and providers, which is an area of ongoing research by our group – these additional dimensions of accommodation and acceptability need to be further addressed. 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.” , concluded Dr. Akinyemiju.
Disclosure: For full disclosures from the study authors, visit jnccn.org.
The content of this article has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the views and opinions of ASCO®.