This article appeared on the Clearity Foundation web site and was written by Jon Kelvey
Black patients with ovarian cancer were less likely than their White counterparts to receive adjuvant chemotherapy after primary surgery, according to a study published in Gynecologic Oncology.
The study also showed that patients who did not undergo adjuvant chemotherapy had worse survival outcomes.
For this study, researchers analyzed National Cancer Database data on patients with stage II-III ovarian cancer who underwent primary surgery.
Of the 48,245 patients, 42,914 were White, 3058 were Black, and 2273 were another race. The patients’ median age was 61 years. There were 522 patients (1.08%) who did not receive adjuvant chemotherapy due to clinician-identified risk factors.
In a multivariate analysis, the following factors were associated with not receiving a recommendation for adjuvant chemotherapy — Black race, being older (≥70 years), having higher Charlson-Deyo comorbidity scores (>0), having government insurance (vs private insurance), and being treated at a community center (vs academic/research center).
When controlling for all other factors, Black race was significantly associated with not being recommended chemotherapy (adjusted odds ratio, 2.12; 95% CI, 1.61-2.78; P <.0001).
Not being recommended for chemotherapy was associated with worse overall survival (OS). The median OS was 53.8 months for those who received adjuvant chemotherapy and 12.1 months for those who did not (adjusted hazard ratio [aHR], 2.74; 95% CI, 2.48-3.03; P <.0001).
OS outcomes were similar for Black and White patients who were not recommended for chemotherapy (aHR, 1.01; 95% CI, 0.74-1.39, P =.951).
Among Black patients, the 5-year OS rate was significantly higher for those who received a recommendation for chemotherapy than for those who did not — 40.3% and 25.9%, respectively (P <.0001).
The researchers noted that, of the 62 Black patients who were deemed too high risk to receive chemotherapy, 31 patients had a risk profile similar to the profiles of White patients who did receive chemotherapy.
These results suggest that risk estimation may be performed unequally on the basis of race. However, due to limitations of the data studied, the researchers could not rule out that other factors might help explain the observed disparity. One limitation is that functional status is not included in National Cancer Database records.
“Additional research is warranted to directly investigate the role of bias, including implicit bias, in clinical decision-making in gynecologic oncology,” the researchers concluded.
Matthews BJ, Qureshi MM, Fiascone SJ, et al. Racial disparities in non-recommendation of adjuvant chemotherapy in stage II-III ovarian cancer. Gynecol Oncol. 2022;164(1):27-33. doi:10.1016/j.ygyno.2021.10.090
This article was published by Cancer Therapy Advisor.
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