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. 
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.

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.

Can you explain your study and why it was conducted?

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. 

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. 

Please discuss the trial design and the results you found.

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.
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. 

Were these results surprising to you?

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. 

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

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.

Talk about this article with other patients, caregivers, and advocates in the Ovarian Cancer CURE discussion group.
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