||5R37CA233777-03 Interpret this number
||A Role of Multilevel Healthcare Access Dimensions in Ovarian Cancer Disparities
Less than 40% of ovarian cancer (OC) patients in the US receive stage-appropriate guideline- adherent
surgery and chemotherapy; Black OC patients are even less likely to receive such treatment. While 5-year
relative survival for White OC patients improved by 47% between 1975 and 2009, it declined by 27% for
Black patients during this same period. Among cancer survivors, Black patients are also observed to have
significantly higher depression, pain, and fatigue than White survivors. These racial disparities are likely due
largely to differences in healthcare access – specifically, access to high quality initial treatment and post-
treatment supportive care. Healthcare access is a complex subject; however, the Penchansky healthcare
access framework proposed that it comprises of five specific dimensions: availability, affordability,
accessibility, accommodation and acceptability of health care services. Our study will comprehensively
evaluate all five dimensions of healthcare access (HCA) among Black and White patients to identify and
quantify the specific factors contributing to the striking racial differences in OC care and survival. More
specifically, we will utilize data from SEER-Medicare (8,060 OC patients) along with primary survey data
from a population-based sample of 1,010 OC patients, linked with several existing datasets (e.g., American
Community Survey, Area Healthcare Resource File), to characterize racial differences in associations
between each HCA dimension and three outcomes: quality of initial treatment and supportive care, quality of
life based on patient-reported outcomes in prevalent yet manageable symptoms, and survival. We will
evaluate HCA dimensions across patient, neighborhood, provider and hospital levels, and utilize hierarchical
regression models with random effects to account for clustering, and multilevel structural equation models to
estimate the total, direct and indirect effect of race on treatment mediated through HCA dimensions. Our
preliminary studies suggest that certain under-studied dimensions (e.g., acceptability) may outweigh other
dimensions (e.g., availability) in determining quality of care. Moreover, the impact of the various HCA
dimensions may vary by race. By analyzing high-quality multilevel datasets with Black and White patients,
we can fully characterize the nature of racial disparities, assess the relative importance of race-specific
barriers to care, and identify race-specific modifiable factors. Our study will provide novel, empirical, and
generalizable insights regarding the distinct and collective influence of HCA dimensions on OC outcomes.
These insights will help identify and prioritize specific modifiable factors that can then be targeted to reduce
disparities and improve care for all patients.
Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis.
, Fowler M.E.
, Mao X.
, Wilson L.E.
, Huang B.
, Pisu M.
, Potosky A.
, Tucker T.
, Akinyemiju T.
JNCI cancer spectrum, 2019 Dec; 3(4), p. pkz084.