Abstract B007: Racial and ethnic disparities in receipt of guideline concordant care among ovarian cancer patients
Authors: Bandera Elisa V. , Collin Lindsay J. , Lee Valerie , Kavecansky Juraj , Garcia Christine , Diaz Carola Sanchez , Khosrow-Khavar Farzin , Doherty Jennifer A. , Gomez Scarlett Lin , Kushi Lawrence H. 
Published: December 2023

Abstract
Background: Black women experience the worst survival after an ovarian cancer diagnosis, compared to any racial and ethnic group, and the mortality gap between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women has continued to widen over the years. Standard of care for ovarian cancer has historically included surgical cytoreduction followed by platinum and taxane-based chemotherapy, with some minor variations over the years in the recommendations for agents, dosing patterns, and treatment sequence, which may affect disparities in adherence to treatment guidelines. The most drastic changes in National Comprehensive Cancer Network (NCCN) guidelines were released in 2016, with the incorporation of histotype in decision trees to guide care. Our study aimed to evaluate racial and ethnic differences in receipt of guideline concordant care in an integrated health system. Methods: This analysis included 4,197 California residents in the KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival) Study, age 18 years or older when diagnosed between 2000 and 2018 with invasive ovarian, fallopian or peritoneal cancer at Kaiser Permanente Northern California, and with available key information to assess guideline concordant care. Detailed surgery and chemotherapy data, as well as clinical characteristics (e.g., grade, stage, histotype), were obtained from electronic medical records. We evaluated concordance with year-specific NCCN guidelines for surgery and chemotherapy according to the year of diagnosis, with independent consideration of recommendations for neoadjuvant and adjuvant therapies. Results: Our study included 2,822 NHW women, 231 NHB women, 558 Asian American and Pacific Islander (AAPI) women, 512 Hispanic women, and 74 women of other races. Overall, we found that NHB women were less likely to receive guideline concordant care than any other groups (37.2% compared to 44.6% for NHW, 55.4% for NHA, and 48.6% for Hispanic women). NHB women were less like to receive surgery, and guideline concordant chemotherapy, including having early discontinuation. Annual trends also revealed persistently lower receipt of guideline treatment among NHB compared with all other groups over time. We also observed for all groups, except AAPI women a lower percentage of concordant care after 2016, most pronounced for NHB women, at 33%, when histotype was incorporated into NCCN guidelines. Conclusions: We found that in a setting with similar insurance coverage, treatment disparities persisted. Our next step will be to further explore the reasons for these treatment differences, including neighborhood context and geographic medical accessibility, as well as other patient characteristics (e.g., comorbidity burden, biological factors), that may also have an impact in disease progression and mortality outcomes.
Citation Format: Elisa V. Bandera, Lindsay J. Collin, Valerie Lee, Juraj Kavecansky, Christine Garcia, Carola Sanchez Diaz, Farzin Khosrow-Khavar, Jennifer A. Doherty, Scarlett Lin Gomez, Lawrence H. Kushi. Racial and ethnic disparities in receipt of guideline concordant care among ovarian cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B007.