Abstract 4829: Pre-diagnostic comorbid conditions and survival among black women with ovarian cancer
Authors: Richards Alicia , Johnson Courtney E. , Alberg Anthony J. , Bandera Elisa V. , Bondy Melissa , Cote Michele L. , Hastert Theresa A. , Haller Kristen , Marks Jeffrey R. , Peters Edward S. , Terry Paul D. , Lawson Andrew B. , Schildkraut Joellen M. , Peres Lauren C. 
Published: March 2024

Abstract
Introduction: Black women with epithelial ovarian cancer (EOC) have worse survival compared to other racial groups, and the causes of these poor outcomes remain unclear. Compared to other racial groups, Black women are disproportionately affected by comorbid conditions which can adversely impact cancer care and outcomes. Thus, we examined the association of pre-diagnostic comorbid conditions and their associated medications with survival among Black women with EOC.
Methods: Using data from Black women with EOC in the African American Cancer Epidemiology Study, we evaluated the self-reported Charlson comorbidity index (CCI) and three cardiometabolic comorbidities (diabetes mellitus, hypertension, and hyperlipidemia). We also characterized whether women with each cardiometabolic condition were using medication for their condition. Kaplan-Meier survival curves and log-rank tests were used to examine survival by the CCI, each cardiometabolic comorbidity, and medication use. Cox proportional hazards regression models were used to examine the association of comorbid conditions and medications with survival while adjusting for age at diagnosis, stage, histotype, and study site.
Results: Among 592 Black women with EOC, 35% had a CCI ≥2, and the prevalence of diabetes, hyperlipidemia, and hypertension was 19%, 31%, and 62%, respectively. Among women with each cardiometabolic condition, the prevalence of medication use for diabetes, hypertension, and hyperlipidemia was 73%, 78%, and 60%. In bivariate analyses, women with a higher CCI, diabetes, hyperlipidemia, and hypertension had worse survival compared to women without these conditions (P&lt;0.05). However, when adjusting for prognostic factors, only a high CCI (≥2 vs. 0) and diabetes were significantly associated with higher hazard of death (HR=1.36, 95% CI=1.06-1.74 and HR=1.40, 95% CI=1.08-1.81, respectively). Investigating the independent associations of each condition included in the CCI with survival revealed that diabetes was largely driving the association of CCI with survival. When considering medication use, women with diabetes, irrespective of medication use, women with hypertension not on medication, and women with hyperlipidemia on medication had worse survival compared to women without these conditions in bivariate models (P&lt;0.05). Compared to women without diabetes, women with diabetes on medication and women with diabetes not on medication had a statistically significant higher hazard of death in multivariable models (HR=1.39, 95% CI=1.02-1.88 and HR=1.63, 95% CI=1.04-2.57, respectively). No associations with survival were observed when considering medication use for hypertension and hyperlipidemia after adjusting for prognostic factors.
Conclusion: Similar to prior studies among White women with EOC, diabetes, regardless of medication status, was strongly associated with poorer survival among Black women with EOC.
Citation Format: Alicia Richards, Courtney E. Johnson, Anthony J. Alberg, Elisa V. Bandera, Melissa Bondy, Michele L. Cote, Theresa A. Hastert, Kristen Haller, Jeffrey R. Marks, Edward S. Peters, Paul D. Terry, Andrew B. Lawson, Joellen M. Schildkraut, Lauren C. Peres. Pre-diagnostic comorbid conditions and survival among black women with ovarian cancer [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 4829.