Journal article
Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients
American journal of clinical oncology, Vol.44(10), pp.544-551
10/01/2021
DOI: 10.1097/COC.0000000000000860
PMCID: PMC8801132
PMID: 34342289
Abstract
National Comprehensive Cancer Network guidelines recommend ovarian cancer patients receive cancer-directed surgery from a gynecologic oncologist surgeon. We aimed to determine if rurality impacts type of surgeon and estimate if the interaction between rurality and type of surgeon impacts cytoreductive surgery, chemotherapy initiation, and survival.
Our population-based cohort of Iowan (N=675) ovarian cancer patients included women diagnosed with histologically confirmed stages IB-IV cancer in 2010 to 2016 at the ages of 18 to 89 years old and who received cancer-directed surgery in Iowa. Multivariable logistic regression analysis and Cox proportional hazards models were used.
Rural (vs. urban) patients were less likely to receive surgery from a gynecologic oncologist (adjusted odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.30-0.78). Rural patients with a gynecologic oncologist (vs. nongynecologic oncologist) surgeon were more likely to receive cytoreduction (OR: 2.84; 95% CI: 1.31-6.14) and chemotherapy (OR: 4.22; 95% CI: 1.82-9.78). Gynecologic oncologist-provided surgery conferred a 3-year cause-specific survival advantage among rural patients (adjusted hazard ratio: 0.57; 95% CI: 0.33-0.97) and disadvantage among urban patients (hazard ratio: 1.77; 95% CI: 1.02-3.06) in the model without treatment covariates. Significance dissipated in models with treatment variables.
The variation in the gynecologic oncologist survival advantage may be because of treatment, referral, volume, or nongynecologic oncologist surgeons' specialty difference by rurality. This is the first study to investigate the ovarian cancer survival advantage of having a gynecologic oncologist surgeon by rurality.
Details
- Title: Subtitle
- Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients
- Creators
- Kristin S Weeks - Department of Epidemiology, College of Public Health, University of IowaCharles F Lynch - Iowa Cancer Registry, State Health Registry of IowaMichele M West - Iowa Cancer Registry, State Health Registry of IowaRyan M Carnahan - Department of Epidemiology, College of Public Health, University of IowaMichael A O'Rorke - Department of Epidemiology, College of Public Health, University of IowaJacob J Oleson - Department of Biostatistics, College of Public Health, University of IowaMegan E McDonald - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IAMary E Charlton - Iowa Cancer Registry, State Health Registry of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of clinical oncology, Vol.44(10), pp.544-551
- DOI
- 10.1097/COC.0000000000000860
- PMID
- 34342289
- PMCID
- PMC8801132
- NLM abbreviation
- Am J Clin Oncol
- ISSN
- 0277-3732
- eISSN
- 1537-453X
- Grant note
- HHSN261201800012I / NCI NIH HHS T32 GM007337 / NIGMS NIH HHS P30 CA086862 / NCI NIH HHS
- Language
- English
- Date published
- 10/01/2021
- Academic Unit
- Epidemiology; Pathology; Biostatistics; Nursing; Obstetrics and Gynecology; Injury Prevention Research Center
- Record Identifier
- 9984214701802771
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