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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

  • Jennifer L. Moss
  • Jeanne Murphy
  • Virginia L. Filiaci
  • Lari B. Wenzel
  • Lori Minasian
  • Sarah M. Temkin
Original Article

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.

Keywords

Health-related quality of life Social determinants of health Travel distance Health insurance Community health Ovarian cancer 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Disclaimer

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.

Supplementary material

520_2018_4340_MOESM1_ESM.docx (19 kb)
Supplementary Table S1 (DOCX 19 kb)

References

  1. 1.
    Jayson GC, Kohn EC, Kitchener HC, Ledermann JA (2014) Ovarian cancer. Lancet 384:1376–1388CrossRefPubMedGoogle Scholar
  2. 2.
    Keim-Malpass J, Mihalko SL, Russell G, Case D, Miller B, Avis NE (2017) Problems experienced by ovarian cancer survivors during treatment. J Obstet Gynecol Neonatal Nurs 46:544–554CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kornblith AB, Thaler HT, Wong G, Vlamis V, McCarthylepore J, Loseth DB et al (1995) Quality of life of women with ovarian cancer. Gynecol Oncol 59:231–242CrossRefPubMedGoogle Scholar
  4. 4.
    Ahmed-Lecheheb D, Joly F (2016) Ovarian cancer survivors’ quality of life: a systematic review. J Cancer Surviv 10:789–801CrossRefPubMedGoogle Scholar
  5. 5.
    Lutgendorf SK, Shinn E, Carter J, Leighton S, Baggerly K, Guindani M, Fellman B, Matzo M, Slavich GM, Goodman MT, Tew W, Lester J, Moore KM, Karlan BY, Levine DA, Sood AK (2017) Quality of life among long-term survivors of advanced stage ovarian cancer: a cross-sectional approach. Gynecol Oncol 146:101–108CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Doll KM, Pinheiro LC, Reeve BB (2017) Pre-diagnosis health-related quality of life, surgery, and survival in women with advanced epithelial ovarian cancer: a SEER-MHOS study. Gynecol Oncol 144:348–353CrossRefPubMedGoogle Scholar
  7. 7.
    Bandera EV, Lee VS, Rodriguez-Rodriguez L, Powell CB, Kushi LH (2016) Racial/ethnic disparities in ovarian cancer treatment and survival. Clin Cancer Res 22:5909–5914CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bristow RE, Chang J, Ziogas A, Anton-Culver H, Vieira VM (2014) Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status. Gynecol Oncol 134:60–67CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bristow RE, Powell MA, Al-Hammadi N, Chen L, Miller JP, Roland PY et al (2013) Disparities in ovarian cancer care quality and survival according to race and socioeconomic status. J Natl Cancer Inst 105:823–832CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Terplan M, Schluterman N, McNamara EJ, Tracy JK, Temkin SM (2012) Have racial disparities in ovarian cancer increased over time? An analysis of SEER data. Gynecol Oncol 125:19–24CrossRefPubMedGoogle Scholar
  11. 11.
    Zeng C, Wen W, Morgans AK, Pao W, Shu X-O, Zheng W (2015) Disparities by race, age, and sex in the improvement of survival for major cancers: results from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program in the United States, 1990 to 2010. JAMA Oncol 1:88–96CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vieira VM, Villanueva C, Chang J, Ziogas A, Bristow RE (2017) Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California. Environ Res 156:388–393CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jones A, Haynes R, Sauerzapf V, Crawford S, Zhao H, Forman D (2008) Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. Eur J Cancer 44:992–999CrossRefPubMedGoogle Scholar
  14. 14.
    Jones A, Haynes R, Sauerzapf V, Crawford S, Zhao H, Forman D (2008) Travel times to health care and survival from cancers in Northern England. Eur J Cancer 44:269–274CrossRefPubMedGoogle Scholar
  15. 15.
    Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L (2015) Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist 20:1378–1385CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Temkin SM, Fleming SA, Amrane S, Schluterman N, Terplan M (2015) Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center. Gynecol Oncol 137:497–502CrossRefPubMedGoogle Scholar
  17. 17.
    Tanke MA, Ikkersheim DE (2012) A new approach to the tradeoff between quality and accessibility of health care. Health Policy 105:282–287CrossRefPubMedGoogle Scholar
  18. 18.
    Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, Mannel RS, Homesley HD, Fowler J, Greer BE, Boente M, Birrer MJ, Liang SX, Gynecologic Oncology Group (2011) Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 365:2473–2483CrossRefPubMedGoogle Scholar
  19. 19.
    U.S. Census Bureau (2018) American FactFinder. https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 2017
  20. 20.
    Shavers VL (2007) Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 99:1013PubMedPubMedCentralGoogle Scholar
  21. 21.
    Basen-Engquist K, Bodurka-Bevers D, Fitzgerald MA, Webster K, Cella D, Hu S, Gershenson DM (2001) Reliability and validity of the functional assessment of cancer therapy–ovarian. J Clin Oncol 19:1809–1817CrossRefPubMedGoogle Scholar
  22. 22.
    Phibbs CS, Luft HS (1995) Correlation of travel time on roads versus straight line distance. Med Care Res Rev 52:532–542CrossRefPubMedGoogle Scholar
  23. 23.
    Mishkin G, Minasian LM, Kohn EC, Noone A-M, Temkin SM (2016) The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies. Gynecol Oncol 143:611–616CrossRefPubMedGoogle Scholar
  24. 24.
    Monk BJ, Huang HQ, Burger RA, Mannel RS, Homesley HD, Fowler J, Greer BE, Boente M, Liang SX, Wenzel L (2013) Patient reported outcomes of a randomized, placebo-controlled trial of bevacizumab in the front-line treatment of ovarian cancer: a Gynecologic Oncology Group Study. Gynecol Oncol 128:573–578CrossRefPubMedGoogle Scholar
  25. 25.
    Luckett T, King M, Butow P, Friedlander M, Paris T (2010) Assessing health-related quality of life in gynecologic oncology: a systematic review of questionnaires and their ability to detect clinically important differences and change. Int J Gynecol Cancer 20:664–684CrossRefPubMedGoogle Scholar
  26. 26.
    Krieger N, Chen JT, Waterman PD, Soobader M-J, Subramanian S, Carson R (2002) Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The public health disparities geocoding project. Am J Epidemiol 156:471–482CrossRefPubMedGoogle Scholar
  27. 27.
    Von Gruenigen VE, Huang HQ, Gil KM, Frasure HE, Armstrong DK, Wenzel LB (2012) The association between quality of life domains and overall survival in ovarian cancer patients during adjuvant chemotherapy: a Gynecologic Oncology Group Study. Gynecol Oncol 124:379–382CrossRefGoogle Scholar
  28. 28.
    Nayfield S, Ganz P, Moinpour C, Cella D, Hailey B (1992) Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials. Qual Life Res 1:203–210CrossRefPubMedGoogle Scholar
  29. 29.
    Phippen N, Secord A, Wolf S, Samsa G, Davidson B, Abernethy A et al (2017) Quality of life is significantly associated with survival in women with advanced epithelial ovarian cancer: an ancillary data analysis of the NRG Oncology/Gynecologic Oncology Group (GOG-0218) study. Gynecol Oncol 147:98–103CrossRefPubMedGoogle Scholar
  30. 30.
    Baicker K, Chandra A (2017) Evidence-based health policy. N Engl J Med 377:2413–2415CrossRefPubMedGoogle Scholar
  31. 31.
    Hoffman C, Paradise J (2008) Health insurance and access to health care in the United States. Ann N Y Acad Sci 1136:149–160CrossRefPubMedGoogle Scholar
  32. 32.
    Walker GV, Grant SR, Guadagnolo BA, Hoffman KE, Smith BD, Koshy M, Allen PK, Mahmood U (2014) Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol 32:3118–3125CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Eom CS, Shin DW, Kim SY, Yang HK, Jo HS, Kweon SS, Kang YS, Kim JH, Cho BL, Park JH (2013) Impact of perceived social support on the mental health and health-related quality of life in cancer patients: results from a nationwide, multicenter survey in South Korea. Psycho-Oncology 22:1283–1290CrossRefPubMedGoogle Scholar
  34. 34.
    Niu X, Roche LM, Pawlish KS, Henry KA (2013) Cancer survival disparities by health insurance status. Cancer Med 2:403–411CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Warren JL, Butler EN, Stevens J, Lathan CS, Noone A-M, Ward KC, Harlan LC (2015) Receipt of chemotherapy among Medicare patients with Cancer by type of supplemental insurance. J Clin Oncol 33:312–318CrossRefPubMedGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  1. 1.National Cancer InstituteBethesdaUSA
  2. 2.George Washington University School of NursingWashingtonUSA
  3. 3.Roswell Park Cancer InstituteBuffaloUSA
  4. 4.University of CaliforniaIrvineUSA
  5. 5.Massey Cancer CenterRichmondUSA

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