Can Treatment at a Large Cancer Center Mitigate Racial Disparities in Ovarian Cancer?

Studies have shown that African American women tend to have worse outcomes after ovarian cancer surgery than their white counterparts. However, Renee Cowan, a gynecologic oncology fellow at Memorial Sloan Kettering Cancer Center in New York City, recently conducted a study to investigate if treating minority patients at a high-volume cancer center would close this gap.

Can you explain your study and why it was conducted?

In an interview with CURE, Cowan discussed her findings, and emphasized how important it is for patients with ovarian cancer to seek care from a gynecologic oncology specialist.Several population-based studies have been conducted out of the California cancer registry, the Maryland cancer registry, in Chicago and on a national scale. These studies have shown that in ovarian cancer black women, in particular, have worse survival outcomes compared with white women. Studies also found that black women are less likely to be treated at high-volume cancer centers than their white counterparts.

Additionally, studies found that patients who are treated at high-volume cancer centers do better than patients who are treated at low-volume cancer centers. And when I say "do better," I mean that they have better surgical outcomes, so there's more likelihood that the surgery will remove all the visible cancer. They also have longer survival times compared with patients who are treated at low-volume cancer centers.

Numerous studies hypothesized why this is: Is it the surgeon and the surgeon's experience or is it the hospital's ability to save patients from various complications? Smaller studies hypothesized that if black patients were treated at high-volume centers at a greater rate, then they would have survival advantages similar to their white counterparts.

Please discuss the trial design and the results you found.

We decided to look at our own cohort of patients to see if there was a difference between our patients who were treated at one center in their survival based on their race or ethnicity. It is a retrospective trial. We looked at the charts of almost 1,000 women who had primary debulking surgery for the primary treatment of their ovarian cancer.

Were these results surprising to you?

Looking ahead, how can patients and providers overcome this issue?

We found that there was no statistically significant difference in survival among black, white, Asian and Hispanic patients. Also, there was no statistically significant difference in the outcome of their surgery. So, they were all equally likely to have an optimal surgical outcome, with optimal meaning that there was no residual disease greater than one centimeter left in their abdomen. Not to us. It went along with our hypothesis that if we could get patients through the door, everyone would be treated the same and have the same outcomes. One of the biggest issues is getting patients in the door. First, patients need to know that if they're diagnosed with a gynecologic cancer, then they should see a gynecologic oncologist. That alone gives them a better chance of survival and better outcomes.

Data has also shown for several disease types, not just ovarian cancer, that if you go to hospitals and providers that have more experience, you're also likely to have better survival and surgical outcomes.

What are the next steps in this line of research?

So, for patients who may unfortunately receive an ovarian cancer diagnosis or have a family member diagnosed with the disease, it would be prudent for them to get second opinions and make sure that they go somewhere where the doctor and their team sees a large volume of patients with ovarian cancer. In the literature, "large volume" means more than 20 cases a year for a surgeon. Our team sees a lot more than that. Our next steps include determining how we can reach out to patients and other primary care providers and get patients to the hospital. But there are other obstacles. For instance, insurance is a big elephant in the room, since a patient can only really go where insurance allows them. However, there are plenty of options.

We've interviewed our black patients whom we treat and talked with them about how they came to our hospital and what their referral mechanisms were. We determined that primary care providers would be a good first step. So, we need to reach out to primary care providers and encourage them to refer their patients who they think have advanced ovarian cancer to a high-volume center.