Impact of distance to care, race, and socioeconomic status on ovarian cancer survival in California: A spatial analysis

Objective: To determine the impact of geographic location on advanced-stage ovarian cancer survival in relation to race and socioeconomic status (SES).

Methods: Patients diagnosed with Stage IIIC/IV epithelial ovarian cancer from 1/1/96 to 12/31/06 were identified from the California Cancer Registry. Generalized additive models (GAMs) were used to identify the spatial distribution of ovarian cancer survival by smoothing residential location. The impact of distance travelled to receive care, race, and SES on survival patterns was assessed while adjusting for age and tumor characteristics.

Results: Of the 11,765 patients identified, 28.6% survived the first 3 years and 12.7% survived the first 5 years. Distance to receive care >32 km was associated with increased odds of surviving 3 years (OR=1.16, 95%CI=1.02-1.33), but not with odds of surviving 5 years (OR=0.99, 95%CI=0.83-1.18). Women of low SES (OR=0.78, 95%CI=0.68-0.90) and African American women (OR=0.60, 95%CI=0.48-0.76) had decreased odds of surviving the first 3 years. After accounting for distance traveled, SES, and race, the odds of surviving the first 3 years was lower in southern California compared to the rest of the state. The further women traveled to receive care, the more likely they were to receive care adherent to National Comprehensive Cancer Network (NCCN) guidelines (p<0.0001).

Conclusions: Traveling long distances (>32km) to receive care is associated with increased odds of surviving the first 3 years with advanced-stage ovarian cancer. Geographic barriers disproportionately affect survival among racial minorities and women of low-SES who are less likely to travel long distances to receive NCCN guideline adherent care.