Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients

Kristin Weeks; Charles F Lynch; Michele West; Ryan Carnahan; Michael O'Rorke; Jacob Oleson; Megan McDonald; Sherri L Stewart; Mary Charlton; Ovarian Cancer Treatment Study

doi:10.1016/j.ygyno.2020.11.006

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Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients

Journal article

Peer reviewed

Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients

Kristin Weeks, Charles F Lynch, Michele West, Ryan Carnahan, Michael O'Rorke, Jacob Oleson, Megan McDonald, Sherri L Stewart, Mary Charlton and Ovarian Cancer Treatment Study

Gynecologic oncology, Vol.160(2), pp.477-484

02/2021

DOI: 10.1016/j.ygyno.2020.11.006

PMCID: PMC7869694

PMID: 33218682

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url

https://www.ncbi.nlm.nih.gov/pmc/articles/7869694View

Open Access

Abstract

Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18-89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010-2012 in Kansas, Missouri and Iowa by rurality. Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24-0.58) and referral to a specialist (OR 0.37, 95% CI 0.23-0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26-1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm. There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.

Adolescent

Adult

Aged

Aged, 80 and over

Cytoreduction Surgical Procedures - statistics & numerical data

Female

Gynecology - organization & administration

Gynecology - statistics & numerical data

Health Services Accessibility - organization & administration

Health Services Accessibility - statistics & numerical data

Healthcare Disparities - statistics & numerical data

Humans

Iowa

Kansas

Medical Oncology - organization & administration

Medical Oncology - statistics & numerical data

Middle Aged

Missouri

Ovarian Neoplasms - diagnosis

Ovarian Neoplasms - surgery

Ovariectomy - statistics & numerical data

Referral and Consultation - organization & administration

Referral and Consultation - statistics & numerical data

Retrospective Studies

Rural Health Services - organization & administration

Rural Health Services - statistics & numerical data

Rural Population - statistics & numerical data

Travel - statistics & numerical data

Urban Health Services - organization & administration

Urban Health Services - statistics & numerical data

Urban Population - statistics & numerical data

Young Adult

Details

Title: Subtitle: Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients
Creators: Kristin Weeks - Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America. Electronic address: kristin-weeks@uiowa.edu
Charles F Lynch - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America; Iowa Cancer Registry, State Health Registry of Iowa, University of Iowa, Iowa City, IA, United States of America
Michele West - Iowa Cancer Registry, State Health Registry of Iowa, University of Iowa, Iowa City, IA, United States of America
Ryan Carnahan - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
Michael O'Rorke - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
Jacob Oleson - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States of America
Megan McDonald - Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
Sherri L Stewart - Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
Mary Charlton - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America; Iowa Cancer Registry, State Health Registry of Iowa, University of Iowa, Iowa City, IA, United States of America
Ovarian Cancer Treatment Study
Resource Type: Journal article
Publication Details: Gynecologic oncology, Vol.160(2), pp.477-484
DOI: 10.1016/j.ygyno.2020.11.006
PMID: 33218682
PMCID: PMC7869694
NLM abbreviation: Gynecol Oncol
ISSN: 0090-8258
eISSN: 1095-6859
Grant note: P30 ES005605 / NIEHS NIH HHS U01DP006299 / ACL HHS CC999999 / Intramural CDC HHS HHSN261201800012I / NCI NIH HHS U01 DP006299 / NCCDPHP CDC HHS T32 GM007337 / NIGMS NIH HHS HHSN261201800012C / NCI NIH HHS P30 CA086862 / NCI NIH HHS
Language: English
Date published: 02/2021
Academic Unit: Epidemiology; Pathology; Biostatistics; Nursing; Obstetrics and Gynecology; Injury Prevention Research Center
Record Identifier: 9984214946602771

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