Racial Disparities, Survival & Secondary Debulking for Ovarian Cancer

描述(申请人提供)：卵巢癌是导致女性癌症死亡的第四大原因。尽管努力改进检测，75%的妇女被诊断为晚期(III或IV)疾病。晚期疾病的主要治疗方法包括切除卵巢、子宫、输卵管和其他受累结构的初级去卵巢手术，然后进行化疗。即使有足够的初级治疗，III期和IV期的复发率也很高，从60%到95%。卵巢癌的存活率和接受适当的初级治疗的种族差异已经被描述。卵巢癌存活率和初次手术治疗的种族差异比比皆是。与白人女性相比，非裔美国女性更有可能在更年轻的时候被诊断出患有卵巢癌，患有晚期疾病，不太可能接受初级手术治疗，在那些确实做过手术的人中，也不太可能进行充分的淋巴结切除。自20世纪90年代初以来，二次去瘤手术，即切除大的肿瘤病变，越来越多地用于治疗复发的卵巢癌。目前的文献表明，这种方法可以提高存活率，但数据有限，因为它不是基于人群，样本量很小，而且大多数研究都是在美国以外的地方进行的。我们建议使用SEER-Medicare来获得卵巢癌复发的估计和复发癌症的不同治疗率。我们将比较首次复发的妇女仅接受化疗和二次去髓核手术(加化疗和不加化疗)的存活率。我们还将评估手术和存活率方面的种族差异。我们的发现有助于为复发卵巢癌患者和医生的治疗决策提供信息，特别是少数族裔妇女对复发卵巢癌的治疗决策。 公共卫生相关性：卵巢癌的二次整形手术越来越多地被实施，尽管其有效性的证据很少。医生和患有复发性卵巢癌的妇女需要更好的证据来指导他们的治疗决策。我们的目标是衡量接受二次去卵巢手术的复发性卵巢癌患者与那些没有使用SEER-Medicare数据的患者的存活率差异。

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.