Gynecology Oncology

General

SGO Report on Disparities, 2014:  Literature review of studies examining disparities in gynecologic oncologic care, with three primary sections on ovarian, endometrial, and cervical cancer.

Racial Inequities in Gyn Oncology, 2020: GYOEDU Video, Dr. Sarah Temkin, Summary of research on inequities in care and outcomes in gynecologic oncology, review of social determinants of health, race as a social construct, and the legacy of racism.

A contemporary framework of health equity applied to gynecologic cancer care: A Society of Gynecologic Oncology evidenced- based review, 2018,This article identifies specific populations at risk for experiencing health inequities, including but not limited to Black, indigenous, trans/gender nonconforming Americans, and those with low English fluency.

Towards the elimination of healthcare disparities in gynecologic oncology: Call to Action, 2018, Arguing that numerous factors drive these disparities in healthcare, not limited to the social construction of race/ethnicity, geographic location, and SES, the authors also discuss provider factors such as bias and cultural differences.

Community Driven Approaches for Reducing Health Disparities in Cancer, 2010,This commentary broadly describes disparities in cancer screening and outcomes in the United States, emphasizing that community engagement is key to closing the disparity gap and increasing access to care.

Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies, 2018,Black and Hispanic women were less likely to undergo lymphadenectomy for stage I ovarian cancer compared to Asian and white women, and Black women were least likely to undergo lymphadenectomy for all scenarios.

Investigating Black-White disparities in gynecologic oncology: Theories, conceptual models, and applications, A substantial body of work from the social sciences, including anthropology, sociology and social epidemiology, has broadened research approaches to the study of health and healthcare inequity experienced by Black Americans.

Vaginal and Vulvar Cancer

Disparities in treatment and survival between African American and White women with vaginal cancer, African American women were more likely to present at a younger age and with more advanced staging compared to white women.

Disparities in Vulvar Cancer reported by the NCD: Influence of Sociodemographic Factor, There was regional variation in the rates of stage III and IV diagnoses across the United States. Older age, Medicare status, and a low or medium case volume were associated with advanced stage diagnoses. Unfortunately, within this disease, surgical approaches and adjuvant radiation do not appear consistent.

Case Study

Structural Racism- a 60 year old Black Woman with Breast Cancer,A case study by NEJM describing the experience of accessing care and the ways in which a system is challenged to produce equitable outcomes.

Cervical Cancer

Delays in definitive cervical cancer treatment: An analysis of disparities and overall survival impact,Delays in time to treatment initiation (TTI) with definitive radiation therapy (RT) or chemotherapy and RT (CRT) for cervical cancer could lead to poorer outcomes.

Disparities Among Cervical Cancer Patients Receiving Brachytherapy, Non-Hispanic Black patients received brachytherapy at a significantly lower rate than non-Hispanic white patients, and patients on Medicaid and MEdicare insurance were also less likely to receive brachytherapy. Many patients in the study did not receive standard of care but overall survival was not affected.

Disparities in the use of adjuvant external beam radiation therapy in node-positive cervical cancer patients following hysterectomy, A large percentage of these patients did not receive EBRT, and Black women were less likely to receive it compared to white women. Increasing travel distance was also associated with decreased likelihood of EBRT

Ovarian Cancer

Ovarian Cancer Studies Aim to Reduce Racial Disparities - National Cancer Institute. A short commentary to understand the causes of racial and ethnic disparities among people with ovarian cancer.

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States - PMC This study demonstrated that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival.

Analysis of racial disparities in stage IIIC epithelial ovarian cancer care and outcomes in a tertiary gynecologic oncology referral center,This is a case-only retrospective analysis of patients undergoing initial treatment for stage IIC epithelial ovarian cancer in a tertiary center that examined whether there were disparities in delivery of care and survival between African American and white patients. The study population, however, included on 39 African American women compared to 336 white women, raising concern that it might not have been powered to detect differences in overall survival.

Disparities in genetics assessment for women with ovarian cancer: Can we do better?,Less than one third of women with ovarian cancer are referred for genetics counseling, and this paper hypothesizes that minority women are even less likely to be referred and undergo genetics testing. This impacts their eligibility for particular chemotherapy regimens and appropriate follow-up care.

Disparities in hospice care among older women dying with ovarian cancer, Hospice referrals occur at variable times for different cancer populations and are often marked by sociodemographic disparities. In a population of ovarian cancer patients over age 65, factors associated with a lack of hospice care during the study period (2001-2005) included age under 80, low-income, non-white race, and patients using fee-for-service Medicare compared to those in managed care.

Disparities in ovarian cancer care quality and survival according to race and socioeconomic status, Black race, Medicare payer status, median household income under $35,000, and lack of insurance were independently associated with a decreased likelihood of receiving NCCN guideline-adherent care. Lack of NCCN-guideline accordant care was also independently associated with poorer survival outcomes.

Disparities in treatment and survival among elderly ovarian cancer patients, non-white race was significantly correclated with not receiving both surgery and chemotherapy. Black race was correlated with overall worse survival even when adequate therapy was received and confounders were controlled for.

Racial disparities in survival in malignant germ cell tumors of the ovary, There were significant differences in histologic tumor type by race, and African AMerican women had worse 5-year survival outcomes compared to white women even after reception of adjuvant treatment and histology were accounted for.

Racial Disparities in Cancer Outcomes, Screening, and Treatment | KFF, A policy review of current issues in ovarian cancer treatment

Endometrial Cancer

MDEDGE Article on Endometrial Cancer disparities, Dr. Rossi argues that healthcare professionals can follow four specific actions to address endometrial cancer disparities.

Disparities in receipt of care for high grade endometrial cancer: a national cancer database analysis, Retrospective cohort study examining whether Hispanic women with high-grade endometrial cancer had different survival outcomes compared to white or African American women.

Disparities in Surgical Care Among Women with Endometrial Cancer, Most women continue to be treated with open abdominal hysterectomies despite level I evidence supporting the use of MIS for treatment, associated with a 2.8-fold increased risk of major perioperative complications. Non-white women and women undergoing surgery outside of a large-volume hospital were more likely to undergo open surgeries.

Disparities in uterine cancer epidemiology, treatment, and survival among African Americans in the United States, African American women comprise 7% of endometrial cancer diagnoses but 14% of endometrial cancer deaths. The most consistent contributors to disparities in mortality were histology and socioeconomic factors.

Untangling the Black-White mortality Gap in Endometrial Cancer: a cohort simulation, In the simulation, 40% of the Black-white mortality gap was reduced by equalizing surgery rates and staging distribution. Notably, this analysis did not include the effects of chemotherapy.

Type II endometrial cancer in Hispanic women: tumor characteristics, treatment, and survival compared to non-hispanic white women, Hispanic women were more likely to present with advanced stage and positive nodal disease, but overall there was no difference in outcome between Hispanic and non-Hispanic white women. Immigrant Hispanic women had more favorable outcomes compared to US-born Hispanic women.

Global Health

Global Ovarian Cancer Health Disparities (2013), Literature review of ovarian health disparities worldwide and within the United States (US).

Global Initiative Against HPV and Cervical Cancer: An organization that tries to improve health literacy and access for women across the world to address cervical cancer and screening.

International Gynecologic Cancer Society’s Global Cancer Equity Programming