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Improved survival in ovarian cancer, with widening survival gaps of races and socioeconomic status: a period analysis, 1983-2012.

ABSTRACT: Introduction: Ovarian cancer is the first leading cause of cancer-related deaths among gynecologic malignancies, and the 7th most common female cancer worldwide. However, previous studies on changes in the long-term survival of ovarian cancer were limited. Methods: Our data were extracted from Surveillance, Epidemiology, and End Results (SEER) registries to assess the incidence and relative survival changes of patients with ovarian cancer during 1983-2012. Patients with ovarian cancer were stratified by age, race, and socioeconomic status (SES). Cox regression analysis and Spearman rank correlation analysis were performed by STATA 12 software. Results: The overall incidence of ovarian cancer per 100,000 decreased from 13.7 to 12.4 to 10.8 over three decades with peak incidence occurring in the 70+ age group at 47.6, 45.7 and 40.2 in each respective decade. Median survival improved from 34 months to 46 months to 52 months over three decades, with the 5-year relative survival rate (RSR) increasing from 39.3% to 43.4% to 45.4% (p < 0.0001). However, Whites showed higher median survival (34 months) than Blacks (27 months) in the first decade, and the survival difference significantly increased to 16 months in the third decade. Additionally, the median survival difference between the low-poverty group and high poverty group increased from 4 months to 12 months in the three decades. Discussion: This study demonstrated the decreasing incidence of ovarian cancer with an observed improvement in relative survival over three decades in a large sample. However, the survival gaps among races and SESs significantly widened over the three decades.

SUBMITTER: Wu J

PROVIDER: S-EPMC6171035 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Improved survival in ovarian cancer, with widening survival gaps of races and socioeconomic status: a period analysis, 1983-2012.

Wu Jinna J Sun Huanhuan H Yang Lewei L Deng Yun Y Yan Yan Y Wang Shuncong S Yang Guangwei G Ma Haiqing H

Journal of Cancer 20180908 19

<b>Introduction:</b> Ovarian cancer is the first leading cause of cancer-related deaths among gynecologic malignancies, and the 7th most common female cancer worldwide. However, previous studies on changes in the long-term survival of ovarian cancer were limited. <b>Methods:</b> Our data were extracted from Surveillance, Epidemiology, and End Results (SEER) registries to assess the incidence and relative survival changes of patients with ovarian cancer during 1983-2012. Patients with ovarian can ...[more]

PMID: 30310512

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Project description:Background:In contrast to the extensive research on socioeconomic gaps in reading and math achievement, little attention has been given to socioeconomic disparities in science skills, particularly during the early years of schooling. This emphasis on later years may be problematic because large socioeconomic disparities emerge in the early years, thus it is crucial to document the size of disparities in science achievement and begin unpacking the range of factors that contribute to these disparities. Additionally, it is crucial to know which components of socioeconomic status are more strongly linked to children's science skills so that resources can be more effectively targeted to address disparities. Using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (N?=?9250), this study examines disparities in science achievement across elementary and middle school related to parental income and parental education separating their effects from each other and from a range of confounding factors. Additionally, it considers whether characteristics of children, families, and schools are pathways through which socioeconomic disparities emerge. Results:Results show moderate gaps in science achievement related to both household income and parental education. The primary pathways through which parental education and family income influenced science achievement was through mathematics and reading achievement. For parental education gaps, smaller indirect effects also operated through access to informal science learning opportunities both inside and outside of the home environment. Conclusion:First, this study highlights the importance of considering the contributions of multiple measures of socioeconomic status, instead of a composite. Second, it shows that socioeconomic disparities in science achievement emerge early and that programs and policies aimed at addressing these gaps may need to target children during the early elementary and preschool years. Third, our findings suggest that elementary instructional approaches that simultaneously address science instruction with reading and/or mathematics instruction will likely be especially important for improving overall science outcomes.

Project description:Ovarian cancer is the leading cause of death among cancers of the female genital tract, with poor outcomes despite chemotherapy. There was a persistent socioeconomic gradient in 1-year survival in England and Wales for more than 3 decades (1971-2001). Inequalities in 5-year survival persisted for more than 20 years but have been smaller for women diagnosed around 2000. We explored one possible explanation.We analysed data on 1406 women diagnosed with ovarian cancer during 1991-1998 and recruited to one of two randomised clinical trials. In the second International Collaborative Ovarian Neoplasm (ICON2) trial, women diagnosed between 1991 and 1996 were randomised to receive either the three-drug combination cyclophosphamide, doxorubicin and cisplatin (CAP) or single-agent carboplatin given at optimal dose. In the ICON3 trial, women diagnosed during 1995-1998 were randomised to receive either the same treatments as ICON2, or paclitaxel plus carboplatin.Relative survival at 1, 5 and 10 years was estimated for women in five categories of socioeconomic deprivation. The excess hazard of death over and above background mortality was estimated by fitting multivariable regression models with Poisson error structure and a dedicated link function in a generalised linear model framework, adjusting for the duration of follow-up and the confounding effects of age, Federation of Gynecology and Obstetrics (FIGO) stage and calendar period.Unlike women with ovarian cancer in the general population, no statistically significant socioeconomic gradient was seen for women with ovarian cancer treated in the two randomised controlled trials. The deprivation gap in 1-year relative survival in the general population was statistically significant at -6.7% (95% CI (-8.1, -5.3)), compared with -3.6% (95% CI (-10.4, +3.2)) in the trial population.Although ovarian cancer survival is significantly lower among poor women than rich women in England and Wales, there was no evidence of an association between socioeconomic deprivation and survival among women with ovarian cancer who were treated and followed up consistently in two well-conducted randomised controlled trials. We conclude that the persistent socioeconomic gradient in survival among women with ovarian cancer, at least for 1-year survival, may be due to differences in access to treatment and standards of care.

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Improved survival in ovarian cancer, with widening survival gaps of races and socioeconomic status: a period analysis, 1983-2012.

Publications

Improved survival in ovarian cancer, with widening survival gaps of races and socioeconomic status: a period analysis, 1983-2012.

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