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Michelle Agustin Aranda, MPH, Marcia L. McGory, MD, David S. Zingmond, MD, PhD, Evan Sekeris, PhD, Melinda Maggard, MD, MSHS, and Clifford Y. Ko, MD, MSHS, FACS. Center for Surgical Outcomes and Quality, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 72-215, Los Angeles, CA 90095, 310-478-3711 x 41243, magustin@mednet.ucla.edu

Background: Ovarian cancer is an aggressive gynecologic malignancy and surgical resection is the mainstay of treatment. Recent literature suggests that high volume surgeons (HVS) have better outcomes for patients with ovarian cancer. However, certain patients may be limited in their ability to access and/or receive care from a HVS. The objective of this study is to determine if racial/ethnic disparities exist for access to HVS for women with ovarian cancer.

Methods: The California Cancer Registry (CCR), the California Patient Discharge Database (PDD), and the 2000 Census File were linked to perform this study. All women with a diagnosis of ovarian cancer were identified in the CCR from 1991-2002 and linked to the PDD using a unique patient identifier. Inclusion criteria for the final cohort of patients were: (1) ovarian cancer resection and (2) presence of a unique surgeon identifier. Categorization of surgeon volume for ovarian cancer resection was defined based on published literature: 1) HVS – 10 or more ovarian cancer resections/year 2) middle volume surgeon (MVS) – 2 to 9/year, and 3) low volume surgeon (LVS) – 1/year. A relative risk (RR) was calculated for each level of surgeon volume by patient race/ethnicity. Statistical significance was based on 95% confidence intervals calculated using bootstrapping with 1000 iterations.

Results: The study cohort comprised 13,477 women with ovarian cancer. The mean age was 57.7 years; 72% were non-Hispanic white, 4% black, 8% Hispanic, 16% Asian. 25% of cases were treated by HVS, 30% by MVS, and 45% by LVS. Black women have a significantly lower adjusted probability (compared to Whites) of undergoing ovarian cancer resection by a HVS (RR: 0.70, p<0.05) as do Hispanics (RR: 0.77, p<0.05). While there was no statistically significant risk for being treated by a MVS for any race, Hispanic women have a statistically significant higher adjusted probability of undergoing ovarian cancer resection by a LVS (RR: 1.1; p<0.05).

Conclusions: There are significant disparities for Black and Hispanic race/ethnicities regarding the use of HVS for ovarian cancer resection, which is important given the demonstrated better outcomes associated with HVS. Systems of selective referral to high volume providers need to address these identified disparities in order to realistically improve survival from ovarian cancer at the population level.

Learning Objectives:

• Describe how administrative databases can be utilized to perform population-based studies on specific diseases, such as ovarian cancer.
• Provide further evidence in support of the volume-outcomes relationship for the mainstay of treatment for ovarian cancer, surgical resection.

Presenting author's disclosure statement:

Any relevant financial relationships? No