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Rural Disparities in Surgical Care from Gynecologic Oncologists Among Midwestern Ovarian Cancer Patients
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2 2021
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Source: Gynecol Oncol. 160(2):477-484
[PDF-957.78 KB]
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Alternative Title:Gynecol Oncol
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Description:Objective
Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care.
Methods
We utilized a retrospective cohort created through extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18–89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010–2012 in Kansas, Missouri and Iowa by rurality.
Results
Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24–0.58) and referral to a specialist (OR 0.37, 95% CI 0.23–0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26–1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤ 1cm.
Conclusion
There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.
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Pubmed ID:33218682
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Pubmed Central ID:PMC7869694
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Volume:160
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Issue:2
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