title: Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California.
abstract: OBJECTIVE
  We sought to investigate the impact of race, socioeconomic status (SES), and health care system characteristics on receipt of specific components of National Comprehensive Cancer Network guideline care for stage IIIC/IV ovarian cancer.
  
  
  METHODS
  Patients diagnosed with stage IIIC/IV epithelial ovarian cancer between Jan. 1, 1996, through Dec. 31, 2006, were identified from the California Cancer Registry. Multivariate logistic regression analyses evaluated differences in surgery, chemotherapy, and treatment sequence according to race, increasing SES (SES-1 to SES-5), and provider annual case volume.
  
  
  RESULTS
  A total of 11,865 patients were identified. Median age at diagnosis was 65.0 years. The overall median cancer-specific survival was 28.2 months. African American race (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.45-2.87) and care by a low-volume physician (OR, 19.72; 95% CI, 11.87-32.77) predicted an increased risk of not undergoing surgery. Patients with SES-1 (OR, 0.71; 95% CI, 0.60-0.85) and those treated at low-volume hospitals (OR, 0.88; 95% CI, 0.77-0.99) or by low-volume physicians (OR, 0.80; 95% CI, 0.70-0.92) were less likely to undergo debulking surgery. African American race (OR, 1.55; 95% CI, 1.24-1.93) and SES-1 (OR, 1.80; 95% CI, 1.35-2.39) were both significant predictors of not receiving chemotherapy. African American patients were also more likely than whites to receive no treatment (OR, 2.08; 95% CI, 1.45-2.99) or only chemotherapy (OR, 1.55; 95% CI, 1.10-2.18). Patients with low SES were more likely to receive no treatment (OR, 1.95; 95% CI, 1.44-2.64) or surgery without chemotherapy (OR, 1.67; 95% CI, 1.38-2.03).
  
  
  CONCLUSIONS
  Among patients with advanced-stage ovarian cancer, African American race, low SES, and treatment by low-volume providers are significant and independent predictors of receiving no surgery, no debulking surgery, no chemotherapy, and nonstandard treatment sequences.
authors.affiliation: Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Long
authors.affiliation: Department of Epidemiology, University of California, Irvine, Irvine, CA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, University of California, Irvine, Irvine, CA.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ziogas
authors.affiliation: Division of Gynecologic Oncology, Irvine Medical Center, University of California, Orange, CA.
authors.forename: Krishnansu S
authors.initials: KS
authors.lastname: Tewari
authors.affiliation: Department of Epidemiology, University of California, Irvine, Irvine, CA.
authors.forename: Hoda
authors.initials: H
authors.lastname: Anton-Culver
authors.affiliation: Division of Gynecologic Oncology, Irvine Medical Center, University of California, Orange, CA. Electronic address: rbristow@uci.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003131:Combined Modality Therapy; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D012923:Social Class; D016019:Survival Analysis; D055815:Young Adult
keywords: disparities; ovarian cancer; race; socioeconomic status