Nourishing Survival: The Impact of Dietary Quality on Black Women With Ovarian Cancer

In an interview with The American Journal of Managed Care^®, Bonnie Qin, PhD, assistant professor at Rutgers Cancer Institute, discusses the inspiration behind her recent study, "Diet and Survival in Black Women With Epithelial Ovarian Cancer."

She also interprets her findings, highlighting that among Black women with the lowest adherence to dietary guidelines, even moderate improvements in prediagnosis dietary quality may improve survival after receiving a high-grade serous ovarian cancer diagnosis.

This transcript has been lightly edited for clarity.

Transcript

Could you first discuss the survival disparities among Black women with ovarian cancer and the factors contributing to their higher mortality rates?

The 5-year relative survival rate for ovarian cancer is 51% overall. For Black women, it is 42%, which is lower than for other racial and ethnic groups. The causes of this survival disparity are likely multilevel and multifactorial, including socioeconomic factors, adherence to treatment guidelines, lifestyle factors, comorbid conditions, and more.

However, we don't know much yet about multilevel factors affecting ovarian cancer survival among Black women, which really motivates the African American Cancer Epidemiology Study, AACES. AACES is a multisite, population-based study aimed at better understanding the causes and survival of ovarian cancer among African American and Black women in the US.

The study's contact PI [principal investigator] is Dr Joellen Schildkraut at Emory University, and it includes many talented, dedicated researchers. This current work is based on data collected from AACES.

Next, could you summarize the objective of your study? What inspired you to investigate this topic?

The objective of this study is to examine associations between prediagnosis dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer. As we just talked about, ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Therefore, identifying strategies, including modifiable lifestyle factors, to improve ovarian cancer survival, especially for Black women, is imperative.

We know poor dietary quality disproportionately affects Black populations, but its association with ovarian cancer survival among Black women remains largely unknown. This strongly motivated us to investigate this topic.

Based on your findings, what is the connection between prediagnosis dietary adherence and survival rates among Black women with high-grade serous ovarian cancer?

In our study of 483 Black women diagnosed with epithelial ovarian cancer, we found no significant difference in overall mortality by diet for the full sample. However, for those with high-grade serous ovarian cancer, which is the most common and lethal subtype of epithelial ovarian cancer, we found that both moderate and high prediagnosis dietary quality compared with the lowest dietary quality were associated with decreased mortality.

Dietary patterns in this study were assessed by the Healthy Eating Index–2020 score, which aligns with the current dietary guidelines for Americans, and the Alternative Healthy Eating Index–2010 score, which aligns with the Healthy Eating Index pyramid.

We grouped women into quartiles based on their adherence to dietary guidelines, with quartile 1 representing the lowest adherence and quartile 4 the highest adherence. We observed that women starting from the second quartile of dietary quality scores had a reduced risk of mortality compared with those in the lowest quartile.

The effect size was not small, with a hazard ratio of 0.63 for quartile 2 compared with quartile 1 and similarly for quartiles 3 and 4. These findings suggest that among Black women with the lowest adherence to dietary guidelines, even modest improvements in prediagnosis dietary quality may improve survival after a high-grade serous ovarian cancer diagnosis.