title: Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival.
abstract: OBJECTIVE
  Among patients with ovarian cancer, African American (AA) women experience poorer survival compared with other race/ethnicity groups. This has been attributed to differences in access to health care.
  
  
  METHODS
  We evaluated racial/ethnic differences in chemotherapy dosing and survival in a cohort study among members of Kaiser Permanente Northern California, and thus with equivalent access to health care. Analyses included epithelial-invasive ovarian cancer cases (n = 793) receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent, with median follow-up of 50 months. Relative dose intensity (RDI) was computed for carboplatin and paclitaxel separately as dose administered per week divided by expected dose per week, and average RDI (ARDI) was then calculated for the regimen. Proportional hazards regression was used to calculate HRs and 95% confidence intervals (CIs) after adjusting for relevant covariates.
  
  
  RESULTS
  Compared with whites, AAs were more likely to have dose reduction (ARDI < 85%), treatment delay, and early discontinuation. Hispanics were also more likely to have dose reduction, but less likely to have early discontinuation or treatment delay. After controlling for prognostic factors including ARDI, AA women had the worst survival. Compared with whites, adjusted HRs (95% CI) for overall mortality were 1.56 (1.01-2.39) for AAs; 0.89 (0.61-1.31) for Asians; and 1.41 (0.98-2.04) for Hispanics. Findings for ovarian cancer-specific mortality were similar.
  
  
  CONCLUSIONS
  Disparities in ovarian cancer treatment and survival in AA persisted among women with equal access to care. These findings warrant further evaluation of biological, personal, and social factors that may be responsible for these differences. Clin Cancer Res; 22(23); 5909-14. ©2016 AACR.
authors: Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. elisa.bandera@rutgers.edu.|Rutgers School of Public Health, Piscataway, New Jersey.|Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors: Elisa V
authors: EV
authors: Bandera
authors: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors: Valerie S
authors: VS
authors: Lee
authors: Precision Medicine, Division of Gynecologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors: Lorna
authors: L
authors: Rodriguez-Rodriguez
authors: Gynecologic Oncology Program, Kaiser Permanente Northern California, San Francisco, California.
authors: C Bethan
authors: CB
authors: Powell
authors: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors: Lawrence H
authors: LH
authors: Kushi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017239:Paclitaxel / Q000627:therapeutic use; D044469:Racial Groups; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel