Abstract
INTRODUCTION: Less than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions-Availability, Affordability, Accessibility, Accommodation and Acceptability-among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities.
METHODS AND ANALYSIS: We will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions.
ETHICS AND DISSEMINATION: Result dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised.
Document Type
Article
Publication Date
10-4-2021
Digital Object Identifier (DOI)
https://doi.org/10.1136/bmjopen-2021-052808
Funding Information
This research was funded by the National Institutes of Health/National Cancer Institute (Grant Number R37CA233777 and 5R37CA23377).
Repository Citation
Akinyemiju, Tomi; Deveaux, April; Wilson, Lauren; Gupta, Anjali; Joshi, Ashwini; Bevel, Malcolm; Omeogu, Chioma; Ohamadike, Onyinye; Huang, Bin; Pisu, Maria; Liang, Margaret; McFatrich, Molly; Daniell, Erin; Fish, Laura Jane; Ward, Kevin; Schymura, Maria; Berchuck, Andrew; and Potosky, Arnold L., "Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): Methodology for a Population-Based Study of Black, Hispanic and White Patients with Ovarian Cancer" (2021). Biostatistics Faculty Publications. 58.
https://uknowledge.uky.edu/biostatistics_facpub/58
Included in
Biostatistics Commons, Obstetrics and Gynecology Commons, Oncology Commons, Preventive Medicine Commons
Notes/Citation Information
Published in BMJ Open, v. 11, issue 10, e052808.
© Author(s) (or their employer(s)) 2021 This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.