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Surviving ovarian cancer can depend on income, location

January 05, 2016 | Robert Bristow, MD, MBA
Dr. Robert Bristow talks with patient

Your ZIP code and how much money you make should not determine the likelihood of you surviving ovarian cancer.

Unfortunately, they might. Your household income and the distance you are from a hospital that performs a lot of ovarian cancer procedures could play a big role in whether you’ll beat the disease.

This is in part why fully two-thirds of the 22,000 U.S. women diagnosed with ovarian cancer each year do not receive adequate care. In California, only 48 percent of ovarian cancer patients survive at least five years.

We can improve those odds by making sure women get care that follows national treatment guidelines.

Where you receive ovarian cancer treatment matters

When you are first diagnosed with ovarian cancer, don’t immediately ask, “What treatment should I receive?” Instead, ask, “Where should I receive treatment?”

Using California Cancer Registry data, we found that how far a woman lives from a high-volume ovarian cancer hospital — one that treats 20 or more ovarian cancer cases a year — directly correlates with her likelihood to receive care that follows National Comprehensive Cancer Network guidelines.

This is important because these guidelines include stage-appropriate surgical procedures and recommended chemotherapy. Research has shown that, if all other factors are equal, women who don’t receive care according to the network’s guidelines are only 70 percent as likely to survive their ovarian cancer as those patients who do.

Orange County residents are fortunate to live near high-volume ovarian cancer hospitals that follow network guidelines, but that is not the case for many California residents.

Shortage of ovarian cancer specialists

One of the main reasons so many women do not receive the best care is limited access to ovarian cancer specialists.

There are roughly 1,000 gynecological oncologists in the United States and 22,000 cases of ovarian cancer diagnosed every year. While these specialists are distributed pretty consistently with the country’s population density, there are still only 1,000 available.

Too often we see women with ovarian cancer receive treatment from healthcare providers who — while perfectly competent in their primary area of care, usually gynecologists — are not trained to perform the highly specialized procedures and treatments needed to successfully fight this disease.

Household income factors into ovarian cancer survival rate

Perhaps even more than geographic location, socio-economic status and household income are dominant drivers of disparity in ovarian cancer care.

Another study I participated in showed that a woman whose median household income is less than $35,000 — no matter where she lives — is less likely to get that top-level care and survive than a woman with a higher income.

While the median household income in California is $61,094, 29 percent of the state’s residents fall below $35,000 — so this is a real concern.

There are many ways lower socioeconomic conditions can jeopardize a woman’s ovarian cancer care, but a few include:

  • Lack of, or not enough, insurance
  • Inability to afford medications that ease chemotherapy’s side effects, which can cause a woman to quit treatment
  • Inability to find or afford childcare or eldercare so the patient can get to her treatments
  • Lack of transportation to appointments

Achieving more equal care for ovarian cancer patients

To ensure better care, first we need to educate women about the existence of gynecological oncologists — what they do and where they are located. You should know you have options beyond your OB-GYN doctor and a general surgeon.

Next, we need to empower women to demand appropriate treatment.

  • Don’t be afraid to quiz your physicians about their level of expertise.
  • Ask questions when you don’t understand what you are being told.
  • Consider getting a second opinion.

We have to find ways to reduce the barriers that keep women from getting the care they need. We are fortunate that we have active social workers who are deeply committed to helping patients work through challenges — from finding shelter if they are homeless to expanding their social network so they have more childcare or transportation support.

The next level of evolution in women’s healthcare will be reconfiguring the delivery system itself. We shouldn’t treat ovarian cancer as we would a simple gynecologic condition such as fibroids, but instead as the complicated six- to nine-month treatment program that it is.

In fact, ovarian cancer programs should be treated like organ transplant programs, in which only highly qualified medical centers are certified to handle them. Because quality of treatment is such a powerful determinant of survival, elevating ovarian cancer treatment is warranted.

The more you know, the more you question and the more you become involved in your care, the better your chance of survival — no matter where you live or how much money you make.

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