Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants.
Support Care Cancer
; 27(2): 531-538, 2019 Feb.
Article
em En
| MEDLINE
| ID: mdl-30003341
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
11_ODS3_cobertura_universal
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1_ASSA2030
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2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Ovarianas
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Qualidade de Vida
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Disparidades nos Níveis de Saúde
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Determinantes Sociais da Saúde
Tipo de estudo:
Clinical_trials
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Prognostic_studies
Aspecto:
Determinantes_sociais_saude
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Equity_inequality
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Patient_preference
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Middle aged
Idioma:
En
Revista:
Support Care Cancer
Ano de publicação:
2019
Tipo de documento:
Article