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FACTORS ASSOCIATED WITH TREATMENT RECEIVED FOR OVARIAN CANCER

This study examines the factors associated with the treatment received for ovarian cancer, including age, stage, insurance coverage, and socioeconomic status.

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FACTORS ASSOCIATED WITH TREATMENT RECEIVED FOR OVARIAN CANCER

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  1. FACTORS ASSOCIATED WITH TREATMENT RECEIVED FOR OVARIAN CANCER AR Kahn, MJ Schymura, K Bauer, R Cress, S Neloms, C O’Malley, S Stewart, JM Wike Ovarian Cancer Treatment Patterns and Outcomes (OCTPO) Study California Cancer Registry Maryland Cancer Registry New York State Cancer Registry National Program of Cancer Registries NAACCR Annual Conference Detroit, Michigan June 5, 2007

  2. Overview of Presentation • Ovarian Cancer Background • Statistics • Course of Disease • Treatment • Methods of OCTPO Study • Results

  3. Ovarian Cancer Facts • Eighth most common cancer among females in the U.S. (approx. 20,000/year) • Behind Breast, Lung, CR, Uterine, NHL, Melanoma, and Thyroid • Fifth most common cause of cancer death among U.S. females (approx. 15,000/year) • Most common gynecological cancer cause of death • Lifetime Risk in U.S. women: 1 in 67 (1.5% risk) • All stage, 5-year relative survival: 45% • Survival of cases with distant spread: 30% • Survival of localized cases: 92% • Percent diagnosed with localized disease: 19% American Cancer Society. Cancer Facts and Figures 2007. Atlanta: American Cancer Society; 2007. Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horner MJ, Howlader N, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2004, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007.

  4. OVARIAN CANCER INCIDENCE AND MORTALITY, U.S. CA, MD, AND N.Y. 2000 Suggested Web citation: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2002 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2005. Available at: www.cdc.gov/cancer/npcr/uscs.

  5. Risk Factors (Most women with Ovarian Cancer have no known risk factors) • Genetics • Family history of early breast, ovarian, or CR cancer • BRCA1 and/or BRCA2 (assoc. with 9% of cases) • Hormones • Early Menarche, Late Menopause • Polycystic Ovaries (increased hormonal environment) • Infertility (use of ovulation-stimulating agents) • Estrogen replacement therapy for ten or more years • Also associated with increased gonadal hormones and epidermal growth factor

  6. Protective Factors • Oral contraceptive use (30-60% reduced risk) • Prolonged breast-feeding • Tubal ligation and hysterectomy • Diet high in vegetables • Currently No Good Screening Method

  7. Ovarian Cancer Characteristics • Approximately 90% are epithelial tumors, originating on ovarian surface. • Tumor cells exfoliate into the peritoneal fluid – also spread through lymphatics. • Multiple peritoneal implants are common.

  8. Standard of Care *Standard of care is a Platinum Alkylating Agent Plus a Taxane ** Minimum surgery for stage 2 or 3 is bilateral salpingo-oophorectomy with hysterectomy

  9. Methods – Study Population • Study Population: • Original Goal: 1500 cases per state - Final data set: 4010 cases • California Registries: All women diagnosed with first primary ovarian carcinomas (not low malignant potential) diagnosed in 1998-2000 • Maryland Cancer Registry: Same selection criteria as CA, but 1997-2000 diagnoses • New York State Cancer Registry: Random sample of patients diagnosed in 1998-2000

  10. Methods – Record Review • Hospital medical records were reviewed, and managing physicians were contacted to provide additional information • Certified Tumor Registrars reabstracted the study variables, including AJCC clinical and pathologic staging elements. • Current Presentation: (3727 epithelial cancers - 3369 with complete stage and tx information)

  11. Methods - Linkages • SES Indicators Derived from 2000 Census • Working class: 66% of population • Under-educated: 25% of adults with less than H.S. • Poverty: 20% of households with incomes below poverty level • Co-morbidities (CA and NY only): Statewide Hospital Discharge Files • ICD-9-CM codes - categorized based on Charlson Index • Vital Status obtained from linkage to state vital statistics files and the National Death Index

  12. Software • Abstract Plus was used for reabstraction. Registry Plus was also used for record consolidation. SAS version 9.1 was used for analysis.

  13. Overall Percentage of Women Receiving the Standard of Care based on Grade and Stage: 70.9% Objective: Identify Factors Associated with NOT Receiving the Standard Treatment

  14. Age <50 50-64 65-79 80+ Stage Ever treated by Gynocologic Oncologist Insurance Coverage Private Medicaid Medicare with Supplement Medicare No Insurance Charlson Index 0 1-4 State of Residency Race_Ethnicity White, Non-Hispanic Black, Non-Hispanic Other, Non-Hispanic Hispanic Urban/Rural 100% Urban 100% Rural Any combination Poverty <20% of block group 20% + of block group Education <25% less than high school 25%+ less than high school Working Class <66% working class 66%+ working class Co-Variates Considered

  15. Percent Standard

  16. Distribution of Surgical Procedures by Ever Being Treated by a Gynecologic Oncologist N=3727

  17. Distribution of Chemotherapies by Ever Being Treated by a Gynecologic Oncologist, for Women with Stage >1 or Grade >2 N=2816

  18. Percent

  19. Distribution of Chemotherapies by Age, for Women with Stage >1 or Grade >2 N=2816

  20. Percent Standard

  21. Distribution of Age Group and TNM Stage* Percent *Based on cases with known stage and treatment

  22. Percent Standard

  23. Percent Standard

  24. PERCENT SEEN* BY GYNECOLOGIC ONCOLOGIST BY PAYER *Not necessarily seen first ** Statistically significant N=3720

  25. Percent Standard N=2334

  26. Percent Standard

  27. Age at Dx by Race_Ethnicity Percent

  28. Stage at Dx by Race_Ethnicity Percent

  29. Distribution of Chemotherapies by Race and Ethnicity, for Women with Stage >1 or Grade >2 N=2816

  30. Percent Standard

  31. Percent Standard

  32. Percent Standard

  33. Reason Given for No ChemotherapyFor Women with Stage 2-4 or Grade >2

  34. SUMMARYFactors Associated with NOT Receiving the Standard Care • Medical • Stage 2, 3, or 4 • Having Co-morbidity • Socio-Demographic • Age older than 64 at diagnosis – especially 80 or older • Black Race • Living in a Census Block Group with Low Education • Living in a 100% urban area • Combination Medical and Socio-Demographic • Not being treated by a Gynecologic Oncologist • Not having Health Insurance

  35. Future Plans • Analyze factors related to specific deviations from the standard treatment (e.g., type of chemotherapy and surgery) • Introduce hospital-specific information for the subset of women for whom the information can be obtained • Continue to link the study cases to death records for annual vital status updates to see any correlation between receiving the standard care and survival

  36. California Katrina Bauer Rosemary Cress Barbara Noble Cynthia O’Malley Maryland Stacey Neloms NPCR Sherri Stewart Jen Wike (Irene Hall) New York Beth Bernard Patricia Brooks Paul Buckley Mary Ellen Hanley Amy Kahn Suzanne Solghan Maria Schymura THIS IS A COLLABORATIVE PROJECT INVOLVING THE FOLLOWING MEMBERS OF THE “OCTPO” STUDY GROUP: This project was supported by cooperative agreement U58/CCU220322 from the CDC

  37. THANK YOU Amy Kahn: ark02@health.state.ny.us 518-474-2255

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