Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer

the role of individual-level and contextual social determinants

Jennifer Moss, Jeanne Murphy, Virginia L. Filiaci, Lari B. Wenzel, Lori Minasian, Sarah M. Temkin

Research output: Contribution to journalArticle

Abstract

Purpose: Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer. Methods: The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL. Results: Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p <.05). Conclusions: Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.

Original languageEnglish (US)
Pages (from-to)531-538
Number of pages8
JournalSupportive Care in Cancer
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2019

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Ovarian Neoplasms
Quality of Life
Health Insurance
Social Determinants of Health
Therapeutics
Fallopian Tube Neoplasms
Drug Therapy
Censuses
Standard of Care
Insurance
Social Class
Cluster Analysis
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Moss, Jennifer ; Murphy, Jeanne ; Filiaci, Virginia L. ; Wenzel, Lari B. ; Minasian, Lori ; Temkin, Sarah M. / Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer : the role of individual-level and contextual social determinants. In: Supportive Care in Cancer. 2019 ; Vol. 27, No. 2. pp. 531-538.
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abstract = "Purpose: Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer. Methods: The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL. Results: Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p <.05). Conclusions: Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.",
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Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer : the role of individual-level and contextual social determinants. / Moss, Jennifer; Murphy, Jeanne; Filiaci, Virginia L.; Wenzel, Lari B.; Minasian, Lori; Temkin, Sarah M.

In: Supportive Care in Cancer, Vol. 27, No. 2, 01.02.2019, p. 531-538.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer

T2 - the role of individual-level and contextual social determinants

AU - Moss, Jennifer

AU - Murphy, Jeanne

AU - Filiaci, Virginia L.

AU - Wenzel, Lari B.

AU - Minasian, Lori

AU - Temkin, Sarah M.

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N2 - Purpose: Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer. Methods: The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL. Results: Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p <.05). Conclusions: Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.

AB - Purpose: Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer. Methods: The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL. Results: Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p <.05). Conclusions: Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.

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