Differences in reasons for failure to receive treatment among non-Hispanic Black and White women diagnosed with epithelial ovarian cancer: An analysis of the National Cancer Database cases (1998-2012)

Objectives:

Treatment differences among non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) contribute to epithelial ovarian cancer survival (OVCA) disparities. Observed racial differences in reasons for failure to receive treatment among racial groups may be due to Medicare-eligibility, which serves as a proxy for insurance coverage. This study characterizes differential reasons for failure to receive surgery and chemotherapy between NHB and NHW women diagnosed with OVCA in the US between 1998-2012, stratified by age (<65 and ≥65).

Methods:

NHB and NHW cases from National Cancer Database (NCDB) were analyzed overall and by stage. Stage was categorized as I, II, III and IV, and age was dichotomized (<65 and ≥65). NHB-NHW differences in demographic and clinical variables were tested using Chi-square test. Reasons for not receiving surgery and chemotherapy were analyzed using North American Association of Central Cancer Registries items. Stage-specific tests of proportions were conducted to examine NHB-NHW differences for each reason for non-receipt of treatment. 

Results:

13982 NHB (8021 <65 and 5961 ≥65) and 159635 NHW (84500 <65 and 75135 ≥65) were analyzed for no surgery and no chemotherapy. More NHB (<65, 5.4% vs. 2.4%, ≥65, 8.8% vs. 5.8%, p<0.05) failed to undergo surgery due to patient, family or guardian refusal. Results also show significant NHB-NHW differences in reasons for failure to receive chemotherapy and these patterns persist in age-group comparisons.

Conclusions:

Differential reasons for refusing surgery or chemotherapy persist among NHB and NHW regardless of Medicare-eligibility. Reasons for these differences should be examined further to better understand racial disparities in OVCA treatment and survival.