Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996-2014.
Geographic disparities
Ovarian cancer
Spatial location
Survival
Journal
Cancer epidemiology
ISSN: 1877-783X
Titre abrégé: Cancer Epidemiol
Pays: Netherlands
ID NLM: 101508793
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
11
05
2020
revised:
12
09
2020
accepted:
13
09
2020
pubmed:
7
10
2020
medline:
13
4
2021
entrez:
6
10
2020
Statut:
ppublish
Résumé
Evidence suggests that geographic location may independently contribute to ovarian cancer survival. We aimed to investigate how the association between residential location and ovarian cancer-specific survival in California varies by race/ethnicity and socioeconomic status. Additive Cox proportional hazard models were used to predict hazard ratios (HRs) and 95% confidence intervals (CI) for the association between geographic location throughout California and survival among 29,844 women diagnosed with epithelial ovarian cancer between 1996 and 2014. We conducted permutation tests to determine a global P-value for significance of location. Adjusted analyses considered distance traveled for care, distance to closest high-quality-of-care hospital, and receipt of National Comprehensive Cancer Network guideline care. Models were also stratified by stage, race/ethnicity, and socioeconomic status. Location was significant in unadjusted models (P = 0.009 among all stages) but not in adjusted models (P = 0.20). HRs ranged from 0.81 (95% CI: 0.70, 0.93) in Southern Central Valley to 1.41 (95% CI: 1.15, 1.73) in Northern California but were attenuated after adjustment (maximum HR = 1.17, 95% CI: 1.08, 1.27). Better survival was generally observed for patients traveling longer distances for care. Associations between survival and proximity to closest high-quality-of-care hospitals were null except for women of lowest socioeconomic status living furthest away (HR = 1.22, 95% CI: 1.03, 1.43). Overall, geographic variations observed in ovarian cancer-specific survival were due to important predictors such as receiving guideline-adherent care. Improving access to expert care and ensuring receipt of guideline-adherent treatment should be priorities in optimizing ovarian cancer survival.
Sections du résumé
BACKGROUND
Evidence suggests that geographic location may independently contribute to ovarian cancer survival. We aimed to investigate how the association between residential location and ovarian cancer-specific survival in California varies by race/ethnicity and socioeconomic status.
METHODS
Additive Cox proportional hazard models were used to predict hazard ratios (HRs) and 95% confidence intervals (CI) for the association between geographic location throughout California and survival among 29,844 women diagnosed with epithelial ovarian cancer between 1996 and 2014. We conducted permutation tests to determine a global P-value for significance of location. Adjusted analyses considered distance traveled for care, distance to closest high-quality-of-care hospital, and receipt of National Comprehensive Cancer Network guideline care. Models were also stratified by stage, race/ethnicity, and socioeconomic status.
RESULTS
Location was significant in unadjusted models (P = 0.009 among all stages) but not in adjusted models (P = 0.20). HRs ranged from 0.81 (95% CI: 0.70, 0.93) in Southern Central Valley to 1.41 (95% CI: 1.15, 1.73) in Northern California but were attenuated after adjustment (maximum HR = 1.17, 95% CI: 1.08, 1.27). Better survival was generally observed for patients traveling longer distances for care. Associations between survival and proximity to closest high-quality-of-care hospitals were null except for women of lowest socioeconomic status living furthest away (HR = 1.22, 95% CI: 1.03, 1.43).
CONCLUSIONS
Overall, geographic variations observed in ovarian cancer-specific survival were due to important predictors such as receiving guideline-adherent care. Improving access to expert care and ensuring receipt of guideline-adherent treatment should be priorities in optimizing ovarian cancer survival.
Identifiants
pubmed: 33022472
pii: S1877-7821(20)30159-4
doi: 10.1016/j.canep.2020.101825
pmc: PMC7710533
mid: NIHMS1634066
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
101825Subventions
Organisme : NIMHD NIH HHS
ID : R01 MD009697
Pays : United States
Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Références
J Clin Oncol. 2005 Dec 20;23(36):9079-88
pubmed: 16301598
Gynecol Oncol. 2015 Dec;139(3):495-9
pubmed: 26387962
J Clin Oncol. 2012 Nov 10;30(32):3976-82
pubmed: 23032619
Gynecol Oncol. 2010 Sep;118(3):262-7
pubmed: 20573392
Support Care Cancer. 2016 Nov;24(11):4739-46
pubmed: 27364149
Obstet Gynecol. 2012 Jan;119(1):68-77
pubmed: 22183213
Health Serv Res. 2006 Dec;41(6):2201-18
pubmed: 17116116
Gynecol Oncol. 2015 Jul;138(1):115-20
pubmed: 25922191
Obstet Gynecol. 2020 Feb;135(2):328-339
pubmed: 31923082
Am J Epidemiol. 2003 Mar 15;157(6):539-45
pubmed: 12631544
Gynecol Oncol. 2015 Jun;137(3):497-502
pubmed: 25795262
Ann Surg Oncol. 2016 Oct;23(11):3444-3452
pubmed: 27126630
Oncology (Williston Park). 1996 Nov;10(11 Suppl):293-310
pubmed: 8953610
Gynecol Oncol. 2015 Jul;138(1):121-7
pubmed: 25913132
JNCI Cancer Spectr. 2019 Oct 09;3(4):pkz084
pubmed: 31840133
Am J Obstet Gynecol. 2015 Jul;213(1):43.e1-43.e8
pubmed: 25644440
Cancer. 2010 Oct 15;116(20):4840-8
pubmed: 20578182
Environ Res. 2017 Jul;156:388-393
pubmed: 28395243
Obstet Gynecol. 2013 Jun;121(6):1226-34
pubmed: 23812456
Gynecol Oncol. 2014 May;133(2):353-61
pubmed: 24406291
Stat Med. 2009 Aug 30;28(19):2473-89
pubmed: 19472308
J Natl Compr Canc Netw. 2012 Nov 1;10(11):1339-49
pubmed: 23138163
Int J Gynecol Cancer. 2014 Sep;24(7):1232-40
pubmed: 25153678
Eur J Cancer. 2008 Jan;44(2):269-74
pubmed: 17888651
J Clin Epidemiol. 1992 Jun;45(6):613-9
pubmed: 1607900
Environ Health Perspect. 2010 Jul;118(7):957-61
pubmed: 20338859
J Natl Compr Canc Netw. 2019 Nov 1;17(11):1318-1329
pubmed: 31693984
Ann Epidemiol. 2015 Aug;25(8):556-63
pubmed: 25986734
Stat Med. 1995 Aug 15;14(15):1707-23
pubmed: 7481205
World J Obstet Gynecol. 2014 May;3(2):71-77
pubmed: 26478860
Cancer Epidemiol. 2019 Feb;58:77-82
pubmed: 30528360
CA Cancer J Clin. 2020 Jan;70(1):7-30
pubmed: 31912902
Ann Surg Oncol. 2016 Mar;23(3):989-93
pubmed: 26511267
Gynecol Oncol. 2014 Feb;132(2):411-5
pubmed: 24246773
Am J Obstet Gynecol. 2015 Apr;212(4):468.e1-9
pubmed: 25448522
Clin Cancer Res. 2016 Dec 1;22(23):5909-5914
pubmed: 27521449
J Natl Cancer Inst. 2013 Jun 5;105(11):823-32
pubmed: 23539755
Gynecol Oncol. 2014 Feb;132(2):403-10
pubmed: 24361578
Clin Epidemiol. 2017 Nov 20;9:601-609
pubmed: 29200890
Gynecol Oncol. 2014 Jul;134(1):60-7
pubmed: 24680770
Cancer. 2017 Dec 15;123 Suppl 24:5138-5159
pubmed: 29205312
J Natl Compr Canc Netw. 2013 Oct 1;11(10):1199-209
pubmed: 24142821
Gynecol Oncol. 2017 Jun;145(3):500-507
pubmed: 28366545
J Clin Oncol. 2003 Sep 15;21(18):3488-94
pubmed: 12972525
Int J Gynecol Cancer. 2013 Feb;23(2):282-7
pubmed: 23295939
Int J Health Geogr. 2006 Jun 09;5:26
pubmed: 16764727
Oncology (Williston Park). 1997 Nov;11(11A):95-105
pubmed: 9430180
Cancer Causes Control. 2001 Oct;12(8):703-11
pubmed: 11562110
Obstet Gynecol. 2017 Sep;130(3):545-553
pubmed: 28796677
J Am Coll Surg. 2017 Aug;225(2):216-225
pubmed: 28414114
Cancer Pract. 1997 Nov-Dec;5(6):361-6
pubmed: 9397704
BMC Cancer. 2008 Sep 12;8:258
pubmed: 18789142
Sci Total Environ. 2019 Dec 20;697:134128
pubmed: 31479898
Gynecol Oncol. 2012 Apr;125(1):19-24
pubmed: 22108636
Gynecol Oncol. 2009 Dec;115(3):334-8
pubmed: 19766295