To compare non-Hispanic White women with racial-ethnic minority women in the equal-access Military Health System in terms of receipt of the National Comprehensive Cancer Network Guideline–adherent therapy for gynecologic malignancies, including uterine, cervical, and ovarian cancer. Researchers used MilCanEpi, a database that connects data from the Department of Defense Central Cancer Registry and administrative claims data from the Military Health System Data Repository, to identify a cohort of women aged 18–79 years who were diagnosed with uterine, cervical, or ovarian cancer. During the data collection period (between January 1, 1998, and December 31, 2014), information on tumor stage, grade, and histology were utilized to determine which treatment(s) (radiotherapy, chemotherapy, surgery) were recommended for each patient based on the National Comprehensive Cancer Network Guidelines. Using multivariable logistic regression models with adjusted odds ratios (aORs) and 95% confidence intervals, they compared non-Hispanic Black, Asian, and Hispanic women to non-Hispanic White women in their probability to get guideline-adherent therapy.
The study comprised 3,354 women with gynecologic cancer, with 68.7% being non-Hispanic White, 15.6% Asian, 9.0% non-Hispanic Black, and 6.7% Hispanic. Overall, 77.8% of patients got therapy in accordance with the guidelines’ treatment (79.1% non-Hispanic White, 75.9% Asian, 69.3% non-Hispanic Black, and 80.5% Hispanic). Guideline-adherent treatment was similar in Asians compared with non-Hispanic White patients (aOR 1.18, 95% CI 0.84–1.48) or Hispanic compared with non-Hispanic White women (aOR 1.30, 95% CI 0.86–1.96). Non-Hispanic Black patients were marginally less likely to receive guideline-adherent treatment compared with non-Hispanic White women (aOR 0.73, 95% CI 0.53−1.00, P=.011) and significantly less likely to receive guideline-adherent treatment than either Asian (aOR 0.65, 95% CI 0.44–0.97) or Hispanic patients (aOR 0.56, 95% CI 0.34–0.92).
Racial–ethnic inequalities in guideline-adherent treatment among equal-access Military Health System patients imply that variables other than access to care contributed to the observed discrepancies.
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