Disparities Persist for Black Women and Ovarian Cancer Care

Most people with ovarian cancer don’t receive treatments recommended 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 with access and affordability. But even after accounting for these factors, the new study found that Black women were 14 percent less likely than white women 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 impacts a patient's cancer care, these do not completely explain racial disparities in ovarian cancer treatment,” lead study author Mary Katherine Montes de Oca, MD, of Duke University School of Medicine, said in a statement.

Treatment guidelines for ovarian cancer typically involve a combination of surgery and chemotherapy and vary based on what’s known as tumor stage, or how advanced and aggressive the cancer appears at the time of diagnosis, according to the American Cancer Society. Staging accounts for the size of the tumors and whether they have spread to surrounding organs, lymph nodes or distant parts of the body.

Most patients get surgery first, typically to remove one or both ovaries and fallopian tubes as well as the uterus, depending on the tumor staging and whether the patient wishes to have children after treatment. When 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 detected.

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

To see how often patients got all of these recommended treatments, researchers examined data on 5,632 patients diagnosed with ovarian cancer between 2008 and 2015 who survived at least one year after their diagnosis. While the majority of patients in the study were white, 6 percent were Black and 6 percent were Hispanic.

Very few patients received complete recommended treatment regimens — just 24 percent of White and Hispanic patients and only 14 percent of Black patients, researchers reported in the Journal of the National Comprehensive Cancer Network.

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

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

“For many reasons, including the legacy of structural racism, Black patients have poorer access to healthcare,” senior study author Tomi Akinyemiju, PhD, of the Duke University School of Medicine, said in a statement.

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