Surviving ovarian cancer may depend on where you live

"The farther a patient lives from a high-volume hospital, the lower their chance of getting the basic standard recommended treatment for ovarian cancer,” says UCI Health gynecologic oncologist Dr. Robert E. Bristow.

Where a woman calls home may affect whether she receives the high-quality standard of care necessary to beat ovarian cancer, the fifth most common cause of cancer death among U.S. woman, a UCI Health study shows.

“We know that many fewer women than we would like are receiving the standard treatment of surgery and chemotherapy for ovarian cancer,” says Robert E. Bristow, MD, MBA, a UCI Health gynecologic oncologist and professor and chair of obstetrics and gynecology at the UCI School of Medicine.

“Over the past decade, we’ve been doing research to find out why.”

Previous research by Bristow and his colleagues has shown that only four in 10 California women diagnosed with ovarian cancer receive the basic standard of care.

Their new study reveals the role geography plays in explaining why these woman also have lower survival rates.

Geography matters

Disparities in ovarian cancer survival rates have been linked to race, ethnicity, socioeconomic status and access to hospitals that treat high volumes of such patients, says Bristow.

The study of 29,844 California women diagnosed with ovarian cancer between 1996 and 2014 — published as “Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996-2014” published in December in the journal Cancer Epidemiology — adds another factor: distance from high-volume treatment centers.

Women receiving treatment at hospitals that see a lot of ovarian cancer cases, such as UCI Medical Center and the UCI Health Chao Family Comprehensive Cancer Center, are more likely to receive the standard of care for their disease than patients at facilities that treat fewer cases.

“The farther a patient lives from a high-volume hospital, the lower their chance of getting the basic standard recommended treatment for ovarian cancer,” says Bristow. “And women of color and lower socioeconomic status tend overall to live farther away from these high-volume hospitals.”

Bristow is careful to say that not all low-volume hospitals provide less than the standard of care. Neither do all high-volume hospitals provide high-quality care. But he believes the expertise and experience of care providers at high-volume centers make the difference.

The study also shows that a woman who was able to travel longer distances to a high-volume center increased her chances of getting the best care.

‘Uphill battle’

“Women of color and women with lower socioeconomic status have a much steeper uphill battle with this disease than a comparable white person,” says Bristow. “They’re more likely to have certain social restrictions on how far they can travel and how much treatment they can get.”

For example, they are more likely to struggle with transportation, child-care issues and financial challenges that may make necessary medications or treatment unaffordable. They also are more likely to suffer co-morbidities, such as cardiovascular disease or diabetes, which may make it more difficult to get through a full course of ovarian cancer treatment.

The study found that women in the southern Central Valley and rural areas of California had lower survival rates when accounting for their distance from high-quality care facilities. Women who did travel greater distances for care had better survival rates.

Reaching health equity

Access to expert, standard-of-care treatment must be prioritized to give every woman an equal chance to survive ovarian cancer, the study concludes.

But achieving health equity for this disease, Bristow explains, will take significant changes in health policy and insurance.

One potential solution is to raise the level of care at low-volume centers or make it easier for women to receive treatment at a high-volume hospital.

Another approach would be to engage health policy administrators on local, state and federal levels to ensure that:

• There is no financial disincentive for large, high-volume ovarian cancer hospitals — and all hospitals in general — to care for women with suspected ovarian cancer
• Women with safety-net insurance, many of whom are women of color or in a lower socioeconomic stratum, are covered for this care

A third option: Elevate ovarian cancer surgery to the same status as bariatric surgery and organ transplantation — in other words, establish centers of excellence with validated performance metrics and buy-in from insurance payers to preferentially send patients to designated centers.

Ultimately, Bristow says, one solution is unlikely to reduce or eliminate survival disparities for women with ovarian cancer.

“It will require a combination of efforts to ensure that all women with ovarian cancer receive the same excellent standard of care, regardless of the color of their skin or socio-economic station in life.”

UCI Health is the clinical enterprise of the University of California, Irvine. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center in Orange, California. The 418-bed acute care hospital provides tertiary and quaternary care, ambulatory and specialty medical clinics, as well as behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.