1. Disparities in care among patients with low-grade serous ovarian carcinoma.
- Author
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Siemon, J., Galli, J., Slomovitz, B., and Schlumbrecht, M.
- Subjects
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CARCINOMA , *FALLOPIAN tubes , *DIAGNOSIS , *GOVERNMENT insurance , *OVARIAN cancer - Abstract
Low-grade serous carcinoma (LGSC) is a rare histotype of ovarian cancer with a unique disease course. Little data exist regarding the influence of sociodemographic factors on diagnosis and outcomes in this disease. Our objective was to evaluate the associations between these factors and the clinical characteristics, treatment approaches, and survival in LGSC. The National Cancer Database (NCDB) was queried for data between 2004 and 2015 on patients with LGSC. LGSC was inclusive of invasive, grade 1, serous carcinoma of the ovary, fallopian tube, or peritoneum. Patient demographics, insurance status, disease characteristics, treatment approach, and survival were evaluated. ANOVA, Chi Square, Kaplan-Meier, and Cox regression were used in the analysis. 3221 patients with LGSC were evaluated (89.5% White, 6.2% Black; 7.2% Hispanic, 92.8% non-Hispanic). Compared to Whites, Blacks were diagnosed younger (50.4 vs. 55.9 years, p < 0.01), received less chemotherapy (61.8% vs 67.0%, p = 0.04), and had less CA-125 elevation (OR 4.14 [1.26–13.57], p = 0.02). Compared to non-Hispanics, Hispanics were younger (49.5 vs. 55.8 years, p < 0.01) and received less chemotherapy (55% vs 67%, p < 0.001). In contrast to private insurance, government insurance was associated with a higher 30-day mortality (1.5% vs 0.01%, p < 0.001). Race/ethnicity were not predictive of OS, while older age (HR 1.013 [1.002–1.024], p = 0.03), advanced stage (HR 3.09 [2.15–4.43], p < 0.001), and government insurance (HR 2.33 [1.65–3.30], p < 0.001) were all independently associated with worse OS. Significant differences exist in the clinical characteristics, treatments, and outcomes of LGSC by sociodemographics, with Blacks and Hispanics being diagnosed younger and receiving less chemotherapy. Age, stage, and insurance status were predictive of overall survival. • Black and Hispanic women are diagnosed with low-grade serous carcinoma at a younger age than white and non-Hispanic women. • Black women are more likely to have elevated CA-125 levels at the time of diagnosis than white women, regardless of stage. • Patients with government insurance have a higher 30-day mortality after primary surgery than patients with private insurance. • Advanced stage, older age, and government payor status are all independently associated with shorter survival. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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