Fertility preservation and survival among young women with early ovarian cancer living in US counties with gynecologic oncologist services.
OBJECTIVE
To examine the association between living in a county with gynecologic oncologist provision, the performance of fertility sparing surgery, and survival among young women with early epithelial ovarian cancer.


METHODS
The present retrospective cohort study was based on the SEER 18 dataset of the US National Cancer Institute. Women younger than 45 years with early stage epithelial ovarian cancer diagnosed between 2000 and 2012 were included. Logistic regression and Cox proportional hazards methods were used to analyze all-cause survival. Adjustment was made for relevant clinical and demographic variables.


RESULTS
In total, 1499 women were included. Women living in a county with gynecologic oncologist provision were less likely to undergo hysterectomy (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.93) at the time of primary surgery. Women who underwent hysterectomy had a similar risk of mortality as women with uterine preservation (adjusted hazard ratio [HR], 0.73; 95% CI, 0.41-1.30). Living in a county with gynecologic oncologist provision was associated with reduced risk of mortality (adjusted HR, 0.53; 95% CI, 0.31-0.92).


CONCLUSIONS
Living in a county with gynecologic oncologist provision was independently associated with the use of fertility sparing surgery among young women with early epithelial ovarian cancer.
Division of Gynecologic Oncology, Department of Reproductive Medicine, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA, USA.
R Tyler
RT
Hillman
Division of Gynecologic Oncology, Department of Reproductive Medicine, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA, USA.
Cheryl C
CC
Saenz
Division of Gynecologic Oncology, Department of Reproductive Medicine, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA, USA.
Michael T
MT
McHale
Division of Gynecologic Oncology, Department of Reproductive Medicine, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA, USA.
Steven C
SC
Plaxe
D000328:Adult; D015331:Cohort Studies; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014932:Women's Health Services / Q000706:statistics & numerical data; D055815:Young Adult
Fertility preservation; Gynecologic oncology; Healthcare disparities; Ovarian cancer