Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients
| Autor: | Michael O'Rorke, Jacob Oleson, Sherri L. Stewart, Michele M. West, Megan E McDonald, Kristin S. Weeks, Charles F. Lynch, Mary E. Charlton, Ryan M. Carnahan |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Rural Population 0301 basic medicine medicine.medical_specialty Adolescent Urban Population Referral Ovariectomy Medical Oncology Health Services Accessibility Article Young Adult 03 medical and health sciences 0302 clinical medicine Urban Health Services medicine Humans Healthcare Disparities Young adult Referral and Consultation Aged Retrospective Studies Aged 80 and over Ovarian Neoplasms Travel Missouri business.industry General surgery Obstetrics and Gynecology Cancer Retrospective cohort study Cytoreduction Surgical Procedures Guideline Odds ratio Kansas Middle Aged medicine.disease Iowa 030104 developmental biology Oncology Gynecology 030220 oncology & carcinogenesis Female Rural Health Services Ovarian cancer business Gynecologic Oncologist |
| Zdroj: | Gynecol Oncol |
| ISSN: | 0090-8258 |
| DOI: | 10.1016/j.ygyno.2020.11.006 |
| Popis: | Objective Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. Methods We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18–89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010–2012 in Kansas, Missouri and Iowa by rurality. Results Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24–0.58) and referral to a specialist (OR 0.37, 95% CI 0.23–0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26–1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm. Conclusion There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them. |
| Databáze: | OpenAIRE |
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