Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): methodology for a population-based study of black, Hispanic and white patients with ovarian cancer.

Journal Article (Journal Article)


Less than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions-Availability, Affordability, Accessibility, Accommodation and Acceptability-among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities.

Methods and analysis

We will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions.

Ethics and dissemination

Result dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised.

Full Text

Duke Authors

Cited Authors

  • Akinyemiju, T; Deveaux, A; Wilson, L; Gupta, A; Joshi, A; Bevel, M; Omeogu, C; Ohamadike, O; Huang, B; Pisu, M; Liang, M; McFatrich, M; Daniell, E; Fish, LJ; Ward, K; Schymura, M; Berchuck, A; Potosky, AL

Published Date

  • October 4, 2021

Published In

Volume / Issue

  • 11 / 10

Start / End Page

  • e052808 -

PubMed ID

  • 34607872

Pubmed Central ID

  • PMC8491419

Electronic International Standard Serial Number (EISSN)

  • 2044-6055

International Standard Serial Number (ISSN)

  • 2044-6055

Digital Object Identifier (DOI)

  • 10.1136/bmjopen-2021-052808


  • eng