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Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study.

Publication ,  Journal Article
Montes de Oca, MK; Wilson, LE; Previs, RA; Gupta, A; Joshi, A; Huang, B; Pisu, M; Liang, M; Ward, KC; Schymura, MJ; Berchuck, A; Akinyemiju, TF
Published in: J Natl Compr Canc Netw
November 2022

BACKGROUND: Racial disparities exist in receipt of guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities. METHODS: We analyzed data from non-Hispanic (NH)-Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of guideline-concordant OC surgery and chemotherapy was defined based on the NCCN Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA. RESULTS: The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01-1.08) and availability (RR, 1.06; 95% CI, 1.02-1.10) were associated with receipt of guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05-1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75-0.99). CONCLUSIONS: Multiple HCA dimensions predict receipt of guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.

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Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

November 2022

Volume

20

Issue

11

Start / End Page

1255 / 1266.e11

Location

United States

Related Subject Headings

  • White People
  • United States
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Medicare
  • Humans
  • Healthcare Disparities
  • Health Services Accessibility
  • Female
  • Carcinoma, Ovarian Epithelial
 

Citation

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Montes de Oca, M. K., Wilson, L. E., Previs, R. A., Gupta, A., Joshi, A., Huang, B., … Akinyemiju, T. F. (2022). Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study. J Natl Compr Canc Netw, 20(11), 1255-1266.e11. https://doi.org/10.6004/jnccn.2022.7055
Montes de Oca, Mary Katherine, Lauren E. Wilson, Rebecca A. Previs, Anjali Gupta, Ashwini Joshi, Bin Huang, Maria Pisu, et al. “Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study.J Natl Compr Canc Netw 20, no. 11 (November 2022): 1255-1266.e11. https://doi.org/10.6004/jnccn.2022.7055.
Montes de Oca MK, Wilson LE, Previs RA, Gupta A, Joshi A, Huang B, et al. Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study. J Natl Compr Canc Netw. 2022 Nov;20(11):1255-1266.e11.
Montes de Oca, Mary Katherine, et al. “Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study.J Natl Compr Canc Netw, vol. 20, no. 11, Nov. 2022, pp. 1255-1266.e11. Pubmed, doi:10.6004/jnccn.2022.7055.
Montes de Oca MK, Wilson LE, Previs RA, Gupta A, Joshi A, Huang B, Pisu M, Liang M, Ward KC, Schymura MJ, Berchuck A, Akinyemiju TF. Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study. J Natl Compr Canc Netw. 2022 Nov;20(11):1255-1266.e11.

Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

November 2022

Volume

20

Issue

11

Start / End Page

1255 / 1266.e11

Location

United States

Related Subject Headings

  • White People
  • United States
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Medicare
  • Humans
  • Healthcare Disparities
  • Health Services Accessibility
  • Female
  • Carcinoma, Ovarian Epithelial