Racial and sociodemographic disparities in the use of targeted therapies in advanced ovarian cancer patients with Medicare
To describe sociodemographic and racial disparities in receipt of poly ADP-ribose polymerase inhibitors (PARPi) and bevacizumab among insured patients with ovarian cancer. This retrospective study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients with advanced stage, high grade serous ovarian cancer diagnosed between 2010 and 2019. The primary outcome of interest was receipt of PARPi or bevacizumab at any time after diagnosis. χ The cohort included 6242 patients; 276 (4.4%) received PARPi, 2142 (34.3%) received bevacizumab, and 389 (6.2%) received both. Receipt of either targeted treatment increased over the study period. On univariate analysis, patients who received either targeted therapy were younger (63% vs 48% aged <75 years; p<0.001), had a lower comorbidity index (86% vs 80% Charlson Comorbidity Index 0-1; p<0.001), and higher socioeconomic status (74% vs 71% high socioeconomic status; p=0.047) compared with those who did not receive targeted therapy. In the multivariable model, non-Hispanic black patients were less likely than non-Hispanic white patients to receive either targeted therapy (odds ratio 0.77; 95% confidence interval 0.61 to 0.98; p=0.032). Older patients (aged >74 years) were also less likely to receive PARPi or bevacizumab compared with those aged 65-69 years (all p<0.001). Sociodemographic and racial disparities exist in receipt of PARPi and bevacizumab among patients with advanced ovarian cancer insured by Medicare. As targeted therapies become more commonly used, a widening disparity gap is likely.
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Funding
Training of Academic Gynecologic OncologistsCancer Center Support GrantNCI NIH HHS Grant HHSN261201800015IAccess to Fertility Specialty Care Among Cancer SurvivorsEffects of biologic and targeted therapies for rheumatoid arthritis on cancer outcomesNCI NIH HHS Grant HHSN261201800032IObstetrical and Oncological Outcomes Among Reproductive Age Women with Gynecological and Breast CancerNCI NIH HHS Grant HHSN261201800009INational Cancer Institute FundingCDC FundingOvarian Cancer Research Program Grant OC210024California Department of Public Health FundingNational Program of Cancer Registries Grant 1NU58DP007156Department of Public Health FundingState of California FundingCenters for Disease Control and Prevention FundingCalifornia Health and Safety Code Section Grant 103885Effects of biologic and targeted therapies for rheumatoid arthritis on cancer outcomesSurveillance, Epidemiology and End Results Program Grant HHSN2612018000091Surveillance, Epidemiology and End Results Program Grant HHSN2612018000151Surveillance, Epidemiology and End Results Program Grant HHSN2612018000321Cancer Center Support GrantTraining of Academic Gynecologic OncologistsObstetrical and Oncological Outcomes Among Reproductive Age Women with Gynecological and Breast CancerAccess to Fertility Specialty Care Among Cancer SurvivorsCPRIT Grant RP210140Fundación Alfonso Martin Escudero FundingDepartment of Defense FundingSAC Grant 150061