Exploring the impact of income and race on survival for women with advanced ovarian cancer undergoing primary debulking surgery at a high-volume center.
OBJECTIVE
To evaluate patients with advanced ovarian cancer (OC) undergoing primary debulking surgery (PDS) at a high-volume center (HVC), to determine whether socio-demographic disparities in PDS outcome and overall survival (OS) were present.


METHODS
All patients with stages IIIB-IV high-grade OC undergoing PDS at our institution from 1/2001-12/2013 were identified. Patients self-identified race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian (A), or Hispanic (H). Income level for the entire cohort was estimated using the census-reported income level for each patient's zip code as a proxy for SES. Main outcome measures were PDS outcome and median OS. Cox proportional hazards model was used to examine differences in OS by racial/ethnic and income category, controlling for selected clinical factors.


RESULTS
963 patients were identified for analysis: 855 NHW; 43 A, 34H, 28 NHB, and 3 unknown. PDS outcome was not significantly different among NHB and H as compared to NHW. Compared to NHW, Asians were more likely to have >1cm residual (AOR 2.32, 95%CI 1.1-4.9, p=0.03). Median income for the entire cohort was $85,814 (range $10,926-$231,667). After adjusting for significant prognostic factors, there were no significant differences in PDS outcome between income groups (p=0.7281). Median OS was 55.1mos (95%CI 51.8-58.5) with no significant differences in OS between the income (p=0.628) or racial/ethnic (p=0.615) groups.


CONCLUSION
Statistically significant socio-demographic disparities in PDS and survival outcomes were not observed among women with advanced OC treated at this HVC. Increased efforts are needed to centralize care to and increase the diversity of pts treated at HVCs.
['Cowan|Renee A|RA|', 'Tseng|Jill|J|', 'Ali|Narisha|N|', 'Dearie|Helen|H|', 'Murthy|Vijayashree|V|', 'Gennarelli|Renee L|RL|', 'Iasonos|Alexia|A|', 'Abu-Rustum|Nadeem R|NR|', 'Chi|Dennis S|DS|', 'Long Roche|Kara C|KC|', 'Brown|Carol L|CL|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000077216:Carcinoma, Ovarian Epithelial D015331:Cohort Studies D065426:Cytoreduction Surgical Procedures D005260:Female D006801:Humans D007182:Income D008875:Middle Aged D009375:Neoplasms, Glandular and Epithelial D010051:Ovarian Neoplasms D044469:Racial Groups D012189:Retrospective Studies D012959:Socioeconomic Factors D016896:Treatment Outcome D055815:Young Adult
Ovarian cancer High volume centers Income disparities Racial disparities