Elizabeth Tracey1, Neville F Hacker, Jane Young, Bruce K Armstrong. 1. *The University of Sydney, Sydney; †The University of New South Wales, Randwick; and ‡Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: The aim of this study was to determine whether the distance of residence from a Gynecological Oncology Service (GOS) was associated with a better survival from ovarian cancer. METHODS: We linked cancer registry records to hospital records for 3749 women with ovarian cancer diagnosed between 2000 and 2008 in New South Wales, Australia. Access to a GOS was measured in kilometers from a woman's geocoded address to the geocoded address of the closest public GOS hospital. Flexible parametric survival, Cox proportional hazards, and logistic regression models were fitted to examine whether better access to a GOS was associated with a better survival and whether extensive surgery was received for ovarian cancer after adjustment for patient, tumor, and treatment factors. RESULTS: Hazard of death from ovarian cancer was greater in women who were treated in a public general hospital than in women treated in a GOS hospital (hazards ratio, 0.77; 95% confidence interval [CI], 0.64-0.95), and greater in those who did not have extensive surgery than in those who did (hazards ratio, 0.47; 95% CI, 0.38-0.58). The further women with ovarian cancer lived from a public GOS hospital, the more likely they were to be treated in a public general hospital. Women were 19 times more likely (odds ratio, 19.40; 95% CI, 13.92-27.04) to be treated only in a general hospital when they lived 187 km or more from a public GOS hospital than women who lived within 5 km of one. CONCLUSIONS: Distance of residence from GOS hospitals in Australia is an important determinant of access to GOS hospitals. Treatment in a public or private GOS hospital and having surgery were the strongest predictors of survival from epithelial ovarian cancer. Research is required into the barriers to referral of patients with ovarian cancer for care in GOS hospitals; low population density limits options for supply of GOS in rural areas.
OBJECTIVE: The aim of this study was to determine whether the distance of residence from a Gynecological Oncology Service (GOS) was associated with a better survival from ovarian cancer. METHODS: We linked cancer registry records to hospital records for 3749 women with ovarian cancer diagnosed between 2000 and 2008 in New South Wales, Australia. Access to a GOS was measured in kilometers from a woman's geocoded address to the geocoded address of the closest public GOS hospital. Flexible parametric survival, Cox proportional hazards, and logistic regression models were fitted to examine whether better access to a GOS was associated with a better survival and whether extensive surgery was received for ovarian cancer after adjustment for patient, tumor, and treatment factors. RESULTS: Hazard of death from ovarian cancer was greater in women who were treated in a public general hospital than in women treated in a GOS hospital (hazards ratio, 0.77; 95% confidence interval [CI], 0.64-0.95), and greater in those who did not have extensive surgery than in those who did (hazards ratio, 0.47; 95% CI, 0.38-0.58). The further women with ovarian cancer lived from a public GOS hospital, the more likely they were to be treated in a public general hospital. Women were 19 times more likely (odds ratio, 19.40; 95% CI, 13.92-27.04) to be treated only in a general hospital when they lived 187 km or more from a public GOS hospital than women who lived within 5 km of one. CONCLUSIONS: Distance of residence from GOS hospitals in Australia is an important determinant of access to GOS hospitals. Treatment in a public or private GOS hospital and having surgery were the strongest predictors of survival from epithelial ovarian cancer. Research is required into the barriers to referral of patients with ovarian cancer for care in GOS hospitals; low population density limits options for supply of GOS in rural areas.
Authors: Keely Krolikowski Ulmer; Breanna Greteman; Nicholas Cardillo; Anthony Schneider; Megan McDonald; David Bender; Michael J Goodheart; Jesus Gonzalez Bosquet Journal: Int J Gynecol Cancer Date: 2022-04-04 Impact factor: 4.661
Authors: Kristin Weeks; Michele West; Charles Lynch; Lisa Hunter; Chelsea Keenan; Savannah Borman; Megan McDonald; Mary Charlton Journal: Womens Health Rep (New Rochelle) Date: 2020-12-28
Authors: Keely K Ulmer; Breanna Greteman; Megan McDonald; Jesus Gonzalez Bosquet; Mary E Charlton; Sarah Nash Journal: Womens Health Rep (New Rochelle) Date: 2022-08-04
Authors: Kristin Weeks; Charles F Lynch; Michele West; Ryan Carnahan; Michael O'Rorke; Jacob Oleson; Megan McDonald; Sherri L Stewart; Mary Charlton Journal: Gynecol Oncol Date: 2020-11-18 Impact factor: 5.482
Authors: Sarah Walters; Sara Benitez-Majano; Patrick Muller; Michel P Coleman; Claudia Allemani; John Butler; Mick Peake; Marianne Grønlie Guren; Bengt Glimelius; Stefan Bergström; Lars Påhlman; Bernard Rachet Journal: Br J Cancer Date: 2015-08-04 Impact factor: 7.640