Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy?

OBJECTIVE: To explore data from the National Cancer Database to identify pretreatment patient characteristics associated with receipt of nonstandard treatment for advanced ovarian cancer.
METHODS: Between 2003 and 2006, there were 47,390 patients with ovarian cancer registered with the National Cancer Database. Variables included demographics, insurance, Charlson comorbidity score, zip income, and facility characteristics. Multivariable log binomial regression analyses were performed to assess factors associated with nonstandard care.
RESULTS: Among the 47,390 patients, 27,045 (81%) were stage IIIC or IV. After excluding patients with missing treatment information (n=1,129 [2.38%]), 13,789 (53.21%) had received standard treatment. In multivariable analyses, uninsured and Medicaid-insured patients were less likely to receive standard treatment as compared with privately insured patients (relative risk 0.88, 95% confidence interval [CI] 0.83-0.93 and relative risk 0.91, 95% CI 0.86-0.95, respectively). African Americans and Hispanics were also less likely to receive standard treatment (relative risk 0.87, 95% CI 0.83-0.92 and relative risk 0.89, 95% CI 0.84-0.94, respectively). Patients with a Charlson comorbidity score of 2+ were less likely to receive standard care (relative risk 0.74, 95% CI 0.68-0.80). Treatment at a community cancer hospital compared with a teaching hospital was also less likely to be associated with standard treatment (relative risk 0.83, 95% CI 0.80-0.87).
CONCLUSION: In this large multi-institutional cohort, approximately 47% of patients with stage IIIC and IV ovarian cancer did not receive standard treatment. Pretreatment patient characteristics such as race, insurance status, age, Charlson comorbidity score, and facility type were associated with nonstandard treatment.