Dissertation
Gynecologic oncologist involvement in rural ovarian cancer patient care: exploring disparities in surgery, chemotherapy, and survival outcomes in the Midwestern United States
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2022
DOI: 10.25820/etd.006454
Abstract
Ovarian cancer is the fifth leading cause of cancer death in women in the United States. One-third of women diagnosed with ovarian cancer do not receive National Comprehensive Cancer Network (NCCN) guideline-recommended surgical care from a gynecologist oncologist (i.e., a physician that specializes in treating cancers associated with the female reproductive system). Receiving surgery from gynecologic oncologists is important because they are the most likely to provide recommended care. NCCN guidelines also recommend chemotherapy consultation from gynecologic oncologists, but the impact of this is under investigated. Gynecologic oncologists predominately provide their services in urban, tertiary hospitals. Consequently, rural patients may be less likely to receive guideline-recommended care. However, the impact of rurality on ovarian cancer care has been understudied. This dissertation constitutes a significant epidemiological investigation exploring critical health service questions and rural-urban differences in outcomes. It aimed to determine if rural ovarian cancer patients are less likely to have a gynecologic oncologist surgeon and chemotherapy provider. Secondly, the independent impact gynecologic oncologists have on treatment, outcomes and survival was examined, while considering the importance of rurality. This dissertation analyzed two population-based cohorts of ovarian cancer patients (diagnosis range: 2010-2016) from the Midwestern United States. Special datasets were created through medical record abstraction and enhanced cancer surveillance. We found that rural patients are less likely to have a gynecologic oncologist surgeon and chemotherapy provider, and gynecologic oncologist-directed surgery was associated with improved surgical outcomes and survival for rural patients. These results will help prioritize ovarian cancer research and interventions.
Details
- Title: Subtitle
- Gynecologic oncologist involvement in rural ovarian cancer patient care: exploring disparities in surgery, chemotherapy, and survival outcomes in the Midwestern United States
- Creators
- Kristin Susan Weeks
- Contributors
- Mary Charlton (Advisor)Charles Lynch (Advisor)Ryan Carnahan (Committee Member)Michael O'Rorke (Committee Member)Jacob Oleson (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Spring 2022
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.006454
- Number of pages
- xvii, 124 pages
- Copyright
- Copyright 2020 Kristin Susan Weeks
- Language
- English
- Description illustrations
- color illustrations, color map
- Description bibliographic
- Includes bibliographical references.
- Public Abstract (ETD)
Ovarian cancer is the fifth leading cause of cancer death in women in the United States. One-third of women diagnosed with ovarian cancer do not receive National Comprehensive Cancer Network (NCCN) guideline-recommended surgical care from a gynecologist oncologist (i.e., a physician that specializes in treating cancers associated with the female reproductive system). Receiving surgery from gynecologic oncologists is important because they are the most likely to provide recommended care. NCCN guidelines also recommend chemotherapy consultation from gynecologic oncologists, but the impact of this is under investigated.
Gynecologic oncologists predominately provide their services in urban, tertiary hospitals. Consequently, rural patients may be less likely to receive guideline-recommended care. However, the impact of rurality on ovarian cancer care has been understudied.
This dissertation constitutes a significant epidemiological investigation exploring critical health service questions and rural-urban differences in outcomes. It aimed to determine if rural ovarian cancer patients are less likely to have a gynecologic oncologist surgeon and chemotherapy provider. Secondly, the independent impact gynecologic oncologists have on treatment, outcomes and survival was examined, while considering the importance of rurality.
This dissertation analyzed two population-based cohorts of ovarian cancer patients (diagnosis range: 2010-2016) from the Midwestern United States. Special datasets were created through medical record abstraction and enhanced cancer surveillance.
We found that rural patients are less likely to have a gynecologic oncologist surgeon and chemotherapy provider, and gynecologic oncologist-directed surgery was associated with improved surgical outcomes and survival for rural patients. These results will help prioritize ovarian cancer research and interventions.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984271056302771
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