Disparities in facility-level adoption of minimally invasive interval debulking surgery for advanced ovarian cancer

Abstract

Objective

Facility-level disparities in the adoption of minimally invasive (MIS) interval debulking surgery (IDS) among Commission-on-Cancer–accredited programs in the United States were examined.

Methods

Patients with stage IIIC or IV epithelial ovarian cancer (2010−2021) who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Analytical periods were categorized as the preadoption (2010 to 2014) and postadoption (2015 to 2021) periods. We defined “Adopter” facilities as those that significantly increased their use of MIS for IDS after 2015 and “non-adopter” facilities as those that restricted the use of this approach after 2015. Hospital-level variation in the use of IDS via MIS was estimated and then adopter programs were matched with non-adopter programs. We examined the associations between characteristics of interest—Black-serving (top 5 %), serving a high proportion of uninsured patients (top 5 %), high-volume (top quartile), and academic—and the tendency to perform IDS using logistic regressions.

Results

We identified 5464 patients treated in 141 adopter facilities and 4820 patients treated in 141 non-adopter facilities. Adopter facilities were less likely than non-adopter facilities to be Black-serving (odds ratio [OR], 0.66; 95 % CI, 0.55–0.79; P < 0.001) and to have a high proportion of uninsured patients (OR, 0.73; 95 % CI, 0.61–0.87, P < 0.001) and more likely to be high-volume centers (OR, 1.48; 95 % CI, 1.35–1.60; P < 0.001) and academic institutions (OR, 1.89; 95 % CI, 1.74–2.04, P < 0.001).

Conclusions

As MIS IDS is adopted in the United States, minoritized patients may have unequal access depending on where they receive care.