Racial/ethnic, socioeconomic, and healthcare access disparities in achieving textbook oncologic outcome in advanced ovarian cancer

Objective

Textbook Oncologic Outcome (TOO) is a composite measure that strongly predicts survival after surgery for advanced epithelial ovarian cancer (AEOC), regardless of approach: primary (PDS) or interval debulking surgery (IDS). We aimed to identify risk factors associated with failure to achieve TOO and to receive standard treatment (surgery and chemotherapy) for AEOC.

Methods

Patients diagnosed with AEOC between 2008 and 2019 were identified using the National Cancer Database. TOO was defined as achieving complete cytoreduction, hospital stay <10 days, no 30-day readmission, adjuvant chemotherapy initiation <42 days, and 90-day survival. Logistic regression models were used to identify factors associated with TOO and receipt of standard treatment.

Results

Among 58,635 AEOC patients, 49% received standard treatment. Of the 21,657 patients who underwent surgery, 51.4% received PDS and 48.6% IDS. For PDS multivariable analysis, factors associated with lower likelihood to achieve TOO included age >75 years (vs <60; OR 0.47, 95% CI 0.38–0.58), Black race (vs White; OR 0.73, 95% CI 0.59–0.90), government insurance (vs private; OR 0.82, 95% CI 0.73–0.92), high surgical complexity (vs low; OR 0.62, 95% CI 0.56–0.68), and median surgical volume ≤5 cases/year (vs ≥20; OR 0.75, 95% CI 0.63–0.89). For IDS, similar associations were observed for government insurance (OR 0.87, 95% CI, 0.80–0.96), high surgical complexity (OR 0.61, 95% CI 0.55–0.66), and median surgical volume ≤5 cases/year (OR 0.60, 95% CI 0.52–0.70).

Conclusions

Several factors are associated with lower likelihood of achieving TOO after treatment for AEOC. Some of these factors (age, race, payor type) reflect disparities in care; others (facility volume, surgical complexity) highlight the need for referral to high-volume centers for initial treatment planning.