Abstract 800: Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California
Authors: Chirikova Ekaterina , Inamdar Pushkar P. , McGuire Valerie , Shariff-Marco Salma , Lee Valerie S. , Collin Lindsay J. , Sanchez-Diaz Carola T. , Kavecansky Juraj , Powell C Bethan , Doherty Jennifer A. , Kushi Lawrence H. , Bandera Elisa V. , Gomez Scarlett L. 
Published: March 2024

Abstract
Introduction: To expand our understanding of factors contributing to racial and ethnic disparities in ovarian cancer outcomes, we examined the association between spatial accessibility of gynecologic oncologists and time from cancer diagnosis to surgery in the KPROCS Study, a diverse cohort of women diagnosed with ovarian cancer between 2000-2018 at Kaiser Permanente Northern California (KPNC). Spatial medical accessibility is a component of healthcare access that captures the proximity and availability of healthcare resources in the area.
Methods: Ovarian cancer cases were identified through the KPNC Cancer Registry. Demographic and clinical information was extracted from KPNC databases. Neighborhood characteristics from the California Neighborhoods Data System were linked to the residential addresses of cases at the time of diagnosis. Spatial medical accessibility was measured using the 2-step floating catchment area method based on the location of the infusion centers where KPNC gynecologic oncologists practice and the residence location of cohort members. We used generalized estimating equations with independent correlation structure and robust standard errors to examine the association between spatial accessibility of gynecologic oncologists and time to ovarian cancer surgery, adjusting for year and age at diagnosis, stage, histotype, race, ethnicity, neighborhood socioeconomic status (nSES), and receipt of neoadjuvant chemotherapy.
Results: The cohort comprised 4,910 women with ovarian cancer, of whom 3,304 had surgery at KPNC. Of this group, 13% were Hispanic, 14% were non-Hispanic (NH) Asian American women, 5% NH Black women, and 67% NH White women. The proportion of women residing in areas of the lowest spatial accessibility of gynecologic oncologists was highest among NH White women (26%) and women residing in the highest quintile of nSES (29%). The median time from diagnosis to surgery was 4 days (interquartile range 22 days). In adjusted analyses, not including the information on spatial accessibility, the time from diagnosis to surgery was 5.1 days longer (95% CI 1.5, 8.7) for NH Black women than NH White women. After adding information on spatial accessibility, this time did not considerably change, resulting in a 5.3-day (95% CI 1.7, 8.9) difference. In this model, the lowest quintile of spatial accessibility of gynecologic oncologists was associated with a longer time from diagnosis to surgery, but this association was not statistically significant (0.4 days difference, 95% CI -1.3, 2.0).
Summary: In our preliminary analyses, spatial accessibility of gynecologic oncologists was not found to be a contributing factor to the disparity in time from diagnosis to surgery between NH Black and NH White women. Further analyses will examine time from diagnosis to chemotherapy overall and stratified by racial and ethnic groups.
Citation Format: Ekaterina Chirikova, Pushkar P. Inamdar, Valerie McGuire, Salma Shariff-Marco, Valerie S. Lee, Lindsay J. Collin, Carola T. Sanchez-Diaz, Juraj Kavecansky, C Bethan Powell, Jennifer A. Doherty, Lawrence H. Kushi, Elisa V. Bandera, Scarlett L. Gomez. Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California [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 800.