Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America; Iowa Cancer Registry, State Health Registry of Iowa, University of Iowa, Iowa City, IA, United States of America.
Gynecol Oncol. 2021 Feb;160(2):477-484. doi: 10.1016/j.ygyno.2020.11.006. Epub 2020 Nov 18.
Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care.
We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18-89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010-2012 in Kansas, Missouri and Iowa by rurality.
Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24-0.58) and referral to a specialist (OR 0.37, 95% CI 0.23-0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26-1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm.
There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.
尽管有指南建议，但美国仍有多达三分之一的卵巢癌女性未接受妇科肿瘤专家的手术治疗。我们旨在研究农村与接受专家手术治疗、转诊给专家以及转诊后专家手术之间的关系，并探讨专家治疗的后果。
我们利用了通过在三个中西部州扩展标准癌症监测创建的回顾性队列。利用多变量调整逻辑回归来评估妇科肿瘤专家对 2010-2012 年在堪萨斯州、密苏里州和爱荷华州被诊断为原发性、组织学确认的恶性卵巢癌的 18-89 岁女性进行治疗的情况，根据农村地区的不同进行分组。
与城市女性相比，农村女性接受妇科肿瘤专家手术治疗（调整后的优势比（OR）为 0.37，95%置信区间（CI）为 0.24-0.58）和转诊给专家（OR 为 0.37，95% CI 为 0.23-0.59）的可能性明显较低。转诊后接受专家手术的可能性没有显著差异（OR 为 0.56，95% CI 为 0.26-1.20）。接受妇科肿瘤专家手术治疗的农村女性比非专家更有可能进行减瘤术和更彻底的肿瘤切除至≤1cm。
在接受妇科肿瘤专家手术治疗卵巢癌方面，农村与城市之间存在着较大的差异（与非专家相比）。转诊率的差异导致了农村与城市之间的差异。进一步的研究将有助于确定转诊差异的原因，以及有希望解决这些差异的策略。
