Uncovering Factors Driving Survival in Hawaiian/Pacific Islander, Asian Indian/Pakistani Patients With Ovarian Cancer

In part 2 of our interview with Alice W. Lee, PhD, MPH, of California State University, Fullerton, she explores why Hawaiian/Pacific Islander patients with ovarian cancer experience the poorest outcomes and why Asian Indian/Pakistani patients have the highest survival rates. Based on her findings, Lee also suggests areas for further research.

Click here to watch part 1 of our interview, where Lee discusses her study's inspiration, objectives, and findings.

This transcript has been lightly edited for clarity.

Transcript

What factors do you think contribute to Hawaiian/Pacific Islander patients experiencing the poorest outcomes, while Asian Indian/Pakistani patients have the highest survival rates?

Such a great question, but, unfortunately, it's not one that we could explore in the data source that we used in this study. That's actually one of the limitations to using cancer registry data, which is what we used; there's absolutely no behavioral or lifestyle information that is available in that database.

With that said, I definitely think that the disparities and outcomes we observed could partly be due to some of these behavioral factors. There's recently been a lot of literature that shows how our lifestyles impact our survival after a cancer diagnosis. So, it really wouldn't surprise me if some of those factors played some role.

For example, we've seen that smoking, as well as having a higher body mass index, are associated with worse ovarian cancer outcomes. These rates are highest among Hawaiians and Pacific Islanders when we're looking at them across the Asian subgroups, and even when we look at it across major racial groups. On the opposite end, Asian Indian/Pakistanis have some of the lowest rates of tobacco use. So, I do think that these sorts of behavioral factors could play a role.

I also want to say that survival is very complicated. It's multifactorial, and there's probably still some factors that we haven't identified yet. That's one of the reasons why we do these analyses that look at racial and ethnic differences. We're hoping they will point us to some of these factors we haven't uncovered yet.

What additional research is needed to build upon your findings?

I think our study is a really great example of what we call descriptive epidemiology. We're describing ovarian cancer survival, and through this descriptive analysis, we've identified these ethnic-specific differences. But what we are not able to do with this descriptive epidemiology approach is to explore the underlying reasons why. We don't know what are the reasons for the disparities we observed.

So, I think that is the next step. Diving deeper into the Hawaiian and Pacific Islander population, for example, to really see what are the unique features about this population that makes them more likely to die from ovarian cancer. I go back to what I was saying earlier, there's limited information in cancer registry data. So, trying to figure out the why is not something that we can do in the analysis. But what I love about descriptive epidemiology with studies like this is that it's all about providing clues. Now we've got clues to help us better understand cancer risk and outcomes. Now that we have this clue, we should look into it some more, particularly in this population.

I also want to say, I've been talking a lot about disaggregation and diversity. Hawaiian and Pacific Islanders, they're also very diverse. It would be really important to look at even further disaggregation because there might be some differences among those specific ethnic groups. Ironically, we've taken an aggregate approach to them, but further disaggregating them would be very relevant.