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The urban-rural gap: Disparities in ovarian cancer survival among patients treated in tertiary centers

  • Kiran H. Clair
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California, Irvine Medical Center, 333 City Blvd. West, Suite 1400, Orange, CA 92868, United States of America.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, United States of America
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  • Robert E. Bristow
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, United States of America
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      Disparities in gynecologic cancer care are a complex ecosystem. Multiple studies have demonstrated a survival advantage for women with ovarian cancer when treated by a gynecologic oncologist [
      • Bristow R.E.
      • Santillan A.
      • Diaz-Montes T.P.
      • et al.
      Centralization of care for patients with advanced-stage ovarian cancer.
      ,
      • Engelen M.J.A.
      • Kos H.E.
      • Willemse P.H.B.
      • et al.
      Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma.
      ,
      • Chan J.K.
      • Kapp D.S.
      • Shin J.Y.
      • et al.
      Influence of the gynecologic oncologist on the survival of ovarian cancer patients.
      ]. However, over one-third of women nationwide live >50 miles from a gynecologic cancer specialist [
      • Stewart S.L.
      Effect of gynecologic oncologist availability on ovarian cancer mortality.
      ]. Rural women are less likely to be referred to and have surgery from a gynecologic oncologist [
      • Weeks K.
      • Lynch C.F.
      • West M.
      • et al.
      Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients.
      ]. Traveling further to receive care has been associated with superior cancer outcomes, however proximity to specialized care such as National Cancer Institute (NCI) designated comprehensive cancer centers or high-volume hospitals (HVHs) has also been associated with better survival [
      • Bristow R.E.
      • Chang J.
      • Ziogas A.
      • Anton-Culver H.
      • Vieira V.M.
      Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status.
      ]. Increased travel demands are a serious burden on a patient's family associated with financial toxicity, disruption of work and livelihood, and less timely initiation of treatment [
      • Ackroyd S.A.
      • Shih Y.-C.T.
      • Kim B.
      • Lee N.K.
      • Halpern M.T.
      A look at the gynecologic oncologist workforce – are we meeting patient demand?.
      ]. Currently, there is limited data examining the potential benefits of ovarian cancer (OC) care at tertiary or NCI centers with respect to rural patients and quality care measures.
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