It has long been identified that Black women with ovarian cancer have worse overall survival when compared to White women, explains Deanna L Huffman, DO, Department of Internal Medicine, Allegheny Health Network, in Pittsburgh. “Several studies suggest that Black patients are less likely to receive treatment as outlined by the National Comprehensive Cancer Network (NCCN) guidelines,” Dr. Huffman says. “Failure to comply with NCCN guidelines is associated with worse survival outcomes in most cancers, including ovarian cancers. This finding is significant because it represents a modifiable risk factor that could be addressed to improve survival outcomes in Black patients. With several health policy changes in the last decade, including the Affordable Care Act, social determinants of health are being increasingly recognized.”
Dr. Huffman and colleagues aimed to perform an updated large, retrospective review using the National Cancer Database (NCDB) to specifically evaluate whether treatment adherence to NCCN guidelines can independently predict Black or White race. “We identified patients diagnosed with ovarian cancer from 2012 to 2016 and defined adherence to NCCN guidelines as having stage and year-appropriate chemotherapy and surgery,” Dr. Huffman says. “Difference in guideline adherence, socioeconomic characteristics, and survival outcomes were assessed.” The study team presented their findings at the recent virtual 2021 Annual Meeting of ASCO.
Adherence to NCCN Guidelines Not Linked With Race
In total, 32,163 patients were identified as meeting the study criteria; 27,744 identified their races as “White” and 2,204 identified their race as “Black.” Characteristics associated with higher likelihood of Black race were advanced state of disease-stage III (odds ration [OR] = 1.1869, confidence interval [CI] = 1.03-1.37) or stage IV disease (OR = 1.4495, CI = 1.23-1.70) and treatment in a comprehensive (OR = 1.5757, CI = 1.16-2.15) or academic (OR = 2.3023, CI = 1.70-3.12) treatment facility. Variables associated with a lower likelihood of Black race were higher education level (OR for high school degree <6.5% = 0.2501, CI = 021-0.30) and higher median household income (OR for income >$63,333 = 0.4218, CI = 036-049).
Whether the care received was adherent to NCCN guidelines did not seem to be associated with Black race (OR for adherence = 1.0021, CI = 0.89-1.13), the study team notes. Five-year overall survival for patients who received adherent care was 58% for White patients versus 49% for Black patients. Among those who did not receive adherent care, the survival outcomes were 49% among White patients versus 38% among Black patients.
Survival Remains Worse for Black Patients
“We found that overall survival remains worse for Black patients, regardless of whether their care adhered to NCCN guidelines as defined by our study,” she says. “This suggests that while receipt of care that is not adherent to NCCN guidelines seems to be negatively associated with overall survival, we must consider and evaluate other socioeconomic, environmental, and system factors that are contributing to this continued survival discrepancy in women being treated for ovarian cancer.”
The study, Dr. Huffman continues, represents a contrast to prior reports since it was performed with only the most recent patient data, excluding cases prior to 2012. “Until survival outcomes are equivalent among all races, clinicians who treat women with ovarian cancer should strive to continue exploring differences in all factors that contribute to survival outcomes,” she concludes.