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Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants

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Abstract

Purpose

Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer.

Methods

The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL.

Results

Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p < .05).

Conclusions

Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.

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Authors and Affiliations

  1. National Cancer Institute, Bethesda, MD, USA

    Jennifer L. Moss & Lori Minasian

  2. George Washington University School of Nursing, Washington, DC, USA

    Jeanne Murphy

  3. Roswell Park Cancer Institute, Buffalo, NY, USA

    Virginia L. Filiaci

  4. University of California, Irvine, CA, USA

    Lari B. Wenzel

  5. Massey Cancer Center, Richmond, VA, USA

    Sarah M. Temkin

Authors
  1. Jennifer L. Moss
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  2. Jeanne Murphy
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  4. Lari B. Wenzel
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  5. Lori Minasian
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Correspondence to Sarah M. Temkin.

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This manuscript was prepared or accomplished by the authors in their personal capacity. The opinions expressed in this article are the authors’ own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the US government. The statements presented in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or its Methodology Committee. Original data are maintained by NRG Oncology.

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Moss, J.L., Murphy, J., Filiaci, V.L. et al. Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants. Support Care Cancer 27, 531–538 (2019). https://doi.org/10.1007/s00520-018-4340-9

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  • DOI: https://doi.org/10.1007/s00520-018-4340-9

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