Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America; The Cooper Institute, Dallas, TX, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America.
Gynecol Oncol. 2024 Nov;190:146-152. doi: 10.1016/j.ygyno.2024.08.017. Epub 2024 Aug 29.
Ovarian cancer has poor 5-year survival, particularly among non-Hispanic (NH) Black patients. Efforts to identify patients at high-risk of functional limitations and frailty may improve outcomes. In this study, we examined how healthcare access (HCA) and race/ethnicity relate to frailty among patients with ovarian cancer.
We identified Hispanic, NH Black, and NH White patients diagnosed at ages ≥6 5 years with ovarian cancer between 2009 and 2015 using SEER-Medicare. Log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between HCA and race/ethnicity with pre- or post-diagnosis frailty, adjusting for age and comorbidities.
A total of 6041 patients with ovarian cancer were included, including 91.8% NH White, 6.6% NH Black, and 1.7% Hispanic. Pre-diagnosis, 14.7% of patients were defined as frail (NH White: 14.3%; NH Black: 17.9%; Hispanic: 20.8%). Post-diagnosis, frailty prevalence increased to 58.8% (NH White: 58.2%; NH Black: 65.2%; Hispanic: 70.2%). No statistically significant associations were observed between race/ethnicity and pre- or post-diagnosis frailty in fully adjusted models. After adjustment for patient characteristics and healthcare accessibility and availability, higher healthcare affordability was associated with a decreased prevalence of pre-diagnosis frailty (PR: 0.91, 95% CI: 0.8 5, 0.98).
Patients with ovarian cancer have a high prevalence of frailty after diagnosis, particularly NH Black and Hispanic patients. Improving healthcare affordability may prevent or help manage frailty in Medicare patients, improve receipt of cancer treatment, and increase cancer survival.
卵巢癌患者的 5 年生存率较差，尤其是非西班牙裔（NH）黑人患者。识别功能受限和虚弱风险较高的患者的努力可能会改善预后。在这项研究中，我们研究了医疗保健可及性（HCA）和种族/民族与卵巢癌患者虚弱的关系。
我们使用 SEER-Medicare 识别了 2009 年至 2015 年间年龄≥65 岁被诊断为卵巢癌的西班牙裔、NH 黑人、NH 白人患者。使用对数二项式回归来估计 HCA 和种族/民族与诊断前或诊断后虚弱之间的关联的患病率比（PR）和 95%置信区间（CI），并调整了年龄和合并症。
共纳入 6041 例卵巢癌患者，其中 91.8%为 NH 白人，6.6%为 NH 黑人，1.7%为西班牙裔。诊断前，14.7%的患者被定义为虚弱（NH 白人：14.3%；NH 黑人：17.9%；西班牙裔：20.8%）。诊断后，虚弱的患病率增加到 58.8%（NH 白人：58.2%；NH 黑人：65.2%；西班牙裔：70.2%）。在完全调整的模型中，种族/民族与诊断前或诊断后虚弱之间没有观察到统计学上的显著关联。在调整了患者特征、医疗保健可及性和可及性后，更高的医疗保健负担能力与诊断前虚弱的患病率降低相关（PR：0.91，95%CI：0.85，0.98）。
卵巢癌患者在诊断后虚弱的患病率较高，尤其是 NH 黑人患者和西班牙裔患者。提高医疗保健负担能力可能有助于预防或管理 Medicare 患者的虚弱，改善癌症治疗的接受程度，并提高癌症的生存率。
