Ovarian cancer is the 4th leading cause of cancer death in women. Despite efforts to improve detection, 75% of women are diagnosed with late stage (III or IV) disease. Primary treatment for late stage disease includes primary debulking surgery in which ovaries, uterus, fallopian tubes and other involved structures are removed, followed by chemotherapy. Even with adequate primary treatment, recurrence rates are high ranging from 60 to 95% for stages III and IV. Racial disparities in both survival from and in receipt of adequate primary treatment of ovarian cancer have been described. Racial disparities in ovarian cancer survival and primary surgical treatment abound. Compared to white women, African American women are more likely to be diagnosed with ovarian cancer at younger ages, with later stage disease, are less likely to undergo primary surgical treatment and among those who do have surgery, and are less likely to have adequate lymph node removal. Since the early 1990s, secondary debulking surgery, in which large tumor lesions are removed, is increasingly performed to treat recurrent ovarian cancer. Current literature suggests this procedure increases survival but data is limited in that it is not population-based, sample sizes are small and most studies are performed out of the US. We propose to use SEER-Medicare to obtain estimates of ovarian cancer recurrence and of various treatment rates for recurrent cancer. We will compare survival rates among women with first recurrence treated with chemotherapy only vs. secondary debulking surgery (with and without chemotherapy). We will also assess racial disparities in surgery and survival. Our findings can help inform both patients with recurrent ovarian cancer and physicians'treatment decision-making, particularly minority women's decisions about treatment for their recurrent ovarian cancer.

Public Health Relevance

Secondary debulking surgery for ovarian cancer is increasingly being performed despite scant evidence of its effectiveness. Physicians and women with recurrent ovarian cancer need better evidence to inform their treatment decision-making.
We aim to measure survival differences in women with recurrent ovarian cancer who undergo secondary debulking surgery versus those who do not using SEER-Medicare data.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA157176-02
Application #
8223160
Study Section
Special Emphasis Panel (ZRG1-HDEP-D (01))
Program Officer
Warren, Joan
Project Start
2011-02-04
Project End
2014-01-31
Budget Start
2012-02-01
Budget End
2013-01-31
Support Year
2
Fiscal Year
2012
Total Cost
$451,915
Indirect Cost
$145,596
Name
Icahn School of Medicine at Mount Sinai
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Howell, Elizabeth A; Egorova, Natalia; Hayes, Monica P et al. (2013) Racial disparities in the treatment of advanced epithelial ovarian cancer. Obstet Gynecol 122:1025-32