Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients
Autor: | Michael O'Rorke, Megan E McDonald, Michele M. West, Charles F. Lynch, Jacob Oleson, Mary E. Charlton, Kristin S. Weeks, Ryan M. Carnahan |
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Rok vydání: | 2021 |
Předmět: |
Adult
Cancer Research medicine.medical_specialty Adolescent Population Article Young Adult Rurality Urban Health Services medicine Humans education Aged Aged 80 and over Ovarian Neoplasms education.field_of_study business.industry Proportional hazards model General surgery Hazard ratio Cancer Odds ratio Middle Aged medicine.disease Iowa Survival Rate Surgical Oncology Oncology Gynecology Cohort Female Rural Health Services business Gynecologic Oncologist |
Zdroj: | Am J Clin Oncol |
ISSN: | 0277-3732 |
Popis: | Background National Comprehensive Cancer Network guidelines recommend ovarian cancer patients receive cancer-directed surgery from a gynecologic oncologist surgeon. We aimed to determine if rurality impacts type of surgeon and estimate if the interaction between rurality and type of surgeon impacts cytoreductive surgery, chemotherapy initiation, and survival. Methods Our population-based cohort of Iowan (N=675) ovarian cancer patients included women diagnosed with histologically confirmed stages IB-IV cancer in 2010 to 2016 at the ages of 18 to 89 years old and who received cancer-directed surgery in Iowa. Multivariable logistic regression analysis and Cox proportional hazards models were used. Results Rural (vs. urban) patients were less likely to receive surgery from a gynecologic oncologist (adjusted odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.30-0.78). Rural patients with a gynecologic oncologist (vs. nongynecologic oncologist) surgeon were more likely to receive cytoreduction (OR: 2.84; 95% CI: 1.31-6.14) and chemotherapy (OR: 4.22; 95% CI: 1.82-9.78). Gynecologic oncologist-provided surgery conferred a 3-year cause-specific survival advantage among rural patients (adjusted hazard ratio: 0.57; 95% CI: 0.33-0.97) and disadvantage among urban patients (hazard ratio: 1.77; 95% CI: 1.02-3.06) in the model without treatment covariates. Significance dissipated in models with treatment variables. Discussion The variation in the gynecologic oncologist survival advantage may be because of treatment, referral, volume, or nongynecologic oncologist surgeons' specialty difference by rurality. This is the first study to investigate the ovarian cancer survival advantage of having a gynecologic oncologist surgeon by rurality. |
Databáze: | OpenAIRE |
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