Review Outlines Barriers to Guideline-Adherent Ovarian Cancer Care

A new scoping review identified barriers to care faced by patients with ovarian cancer.

These can include hospital and physician volumes, a lack of patient and physician education, demographic factors, and physical distance from care facilities, according to findings published in the journal Cureus.

“Ovarian cancer is a leading cause of female cancer-related deaths, but patients continue to be diagnosed late,” the authors wrote. This lack of early detection can subject patients to both disease progression and potentially death.

Early detection improves patient survival rates and is related to access to care. However, barriers preclude many patients from receiving recommended care in accordance with treatment guidelines, the researchers explained.

To better understand barriers that contribute to care inequities, the investigators reviewed 10 studies that included surveys, evidence-based reviews, and database extractions.

When it comes to care equity, the studies revealed low socioeconomic status, race, type of insurance, and fluency in a language other than English all contributed to the low number of women with diagnosed ovarian cancer who receive recommended care. Low-volume surgeons and hospitals were also linked with less care received.

“The observed/expected ratios for adherence to ovarian cancer treatment guidelines at hospitals were another important factor influencing the level of care,” the authors wrote.

“Hospitals with high observed/expected ratios had disease-specific survival times of 68.6 to 79.3 months compared to hospitals with low observed/expected ratios with survival times of 44.8 to 50.8 months,” they found. These associations remained after controlling for variables.

What’s more, patients who lived in closer proximity to a high-volume hospital were more likely to receive guideline-adherent care, while patients with a higher socioeconomic status were more likely to be closer to these facilities.

Access to ovarian care providers is especially limited for patients with a low socioeconomic status and racial minorities. These patients are also less likely to receive hospice care.

“These inequities lead to an overall survival disadvantage for many patients with risk factors for lower quality of care,” the authors wrote.

According to the studies, many patients were misinformed about several aspects of ovarian cancer, including hormone therapy and managing sexual problems. A small percentage were also aware of testing availability for the BRCA gene, while Black patients were least aware about options for genetic testing.

“Medical professionals were also poorly informed about how to care for women with ovarian cancer,” the researchers said.

Risk-reducing bilateral salpingo-oophorectomy can significantly reduce deaths from ovarian; however, high-risk patients reported loss of fertility and symptoms related to surgical menopause as barriers to this treatment option. In addition, some patients reported they were uninformed about postsurgical outcomes. This could be due to a lack of awareness among health care providers.

Several factors can contribute to non–guideline-adherent care, including patients’ medical comorbidities and a lack of physicians, “but the bottom line is that increasing adherence to guideline-accepted treatment methods is essential in increasing survival rates across the board,” the authors stressed.

Different methods of data collection were employed in each study, marking a limitation to the review. In addition, recall bias may have been present. Articles also were only included in the review if they were published after 2002.

Overall, more research is needed on barriers to care for patients with ovarian cancer.

“The findings of this review will provide health experts and patients with better insight into what barriers may exist and how they may be curtailed for more efficient ovarian cancer management and guideline-adherent care,” the authors concluded.

Reference

Rizvi Z, Sharma KC, Kunder V, Abreu A. Barriers of care to ovarian cancer: a scoping revies. Cureus. Published online June 12, 2023. doi:10.7759/cureus.40309