Racial Disparities, Survival & Secondary Debulking for Ovarian Cancer

描述（由申请人提供）：卵巢癌是女性癌症死亡的第四大原因。尽管努力提高检测，75%的妇女被诊断为晚期（III或IV）疾病。晚期疾病的主要治疗包括主要的减瘤手术，其中卵巢，子宫，输卵管和其他相关结构被切除，然后化疗。即使有充分的初级治疗，III期和IV期的复发率也很高，从60%到95%不等。已经描述了卵巢癌的生存率和接受充分的初级治疗的种族差异。卵巢癌生存率和初次手术治疗的种族差异比比皆是。与白色女性相比，非洲裔美国女性更容易在年轻时被诊断出患有卵巢癌，疾病晚期，不太可能接受初次手术治疗，并且在那些确实接受手术的人中，不太可能有足够的淋巴结切除。自20世纪90年代初以来，越来越多地进行二次减瘤手术来治疗复发性卵巢癌，其中切除大的肿瘤病变。目前的文献表明，该手术可提高生存率，但数据有限，因为它不是基于人群的，样本量小，大多数研究都是在美国以外进行的。我们建议使用SEER医疗保险来获得卵巢癌复发和各种复发性癌症治疗率的估计。我们将比较首次复发的女性仅接受化疗与二次减瘤手术（有或无化疗）的生存率。我们还将评估手术和生存的种族差异。我们的研究结果可以帮助告知复发性卵巢癌患者和医生的治疗决策，特别是少数民族妇女关于复发性卵巢癌治疗的决定。 公共卫生相关性：尽管缺乏有效性的证据，但卵巢癌的二次减瘤手术越来越多。复发性卵巢癌的医生和妇女需要更好的证据来告知他们的治疗决策。我们的目的是测量复发性卵巢癌患者接受二次减瘤手术与不使用SEER医疗保险数据的患者的生存差异。

DESCRIPTION (provided by applicant): 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.