Abstract 4837: Perceived discrimination, medical mistrust, and their associations with ovarian cancer mortality among women in the African American Cancer Epidemiology Study
Authors: Collin Lindsay Jane , Johnson Courtney , Akonde Maxwell , Kan Mary , Bandera Elisa V. , Peres Lauren , Alberg Anthony , Hastert Theresa , Schildkraut Joellen 
Published: March 2024

Background: There are pronounced racial disparities in ovarian cancer mortality wherein Black women are on average 30% more likely to succumb to their disease than White women. Factors that contribute to these disparities are complex and multifactorial. Racial discrimination is hypothesized to affect cancer health disparities through three distinct pathways including the impact on socioeconomic inequities, chronic stress, and restricted access to goods and services. In this study, we examined the role of perceived discrimination and medical mistrust on all-cause mortality among ovarian cancer patients.

Methods: Using data from the African American Cancer Epidemiology Study (AACES), we included 592 ovarian cancer patients who self-identified as Black or African American and completed a telephone interview. Perceived discrimination was measured with a modified version of the 5-question Williams Everyday Discrimination scale. Medical mistrust was measured with the Trust in Physician scale (ranged 0-48 based on a combination of 12 questions). We used Cox proportional hazard models to compute hazard ratios (HR) and 95% confidence intervals (CIs) associating perceived discrimination and medical mistrust with all-cause mortality, adjusting for age, stage, and histotype.

Results: Nearly two-thirds of the cohort passed away by the end of follow-up (mean follow-up 5.5 years, ranging 0.5-12 years). We observed that 231 participants patients (39%) reported experiencing discrimination in at least one of the domains assessed. Reporting any experience of discrimination was associated with lower all-cause mortality (HR=0.78, 95% CI: 0.62, 0.97). In multivariable adjusted models, higher trust in physicians (above vs. below the median of 35) was associated with a decreased risk of mortality (HR=0.87, 95% CI: 0.70, 1.08).

Conclusion: In our preliminary results, we observed an association between any experience of discrimination and better survival, and that a higher trust in physicians was associated with better survival. Further work on this project will try to understand the paradoxical association with perceived discrimination, and evaluate the associations of discrimination and medical mistrust with ovarian cancer treatment, leading to more insight into drivers of racial disparities in ovarian cancer mortality.

Citation Format: Lindsay Jane Collin, Courtney Johnson, Maxwell Akonde, Mary Kan, Elisa V. Bandera, Lauren Peres, Anthony Alberg, Theresa Hastert, Joellen Schildkraut. Perceived discrimination, medical mistrust, and their associations with ovarian cancer mortality among women in the African American Cancer Epidemiology Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4837.