Trial Participation May Offset Disparities in Ovarian Cancer Care

A single-institution study of patients with advanced/recurrent EOCs found no overall survival differences for Caucasians and minorities who had participated in a clinical trial.

Racial disparities in survival are dramatically smaller among women who participate in clinical trials, according to a single-institution study of patients with recurrent epithelial ovarian, fallopian tube, and peritoneal cancers (EOCs), presented at the 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, held March 24–27 in New Orleans, Louisiana.

“There were no differences in overall survival for Caucasians and minorities if they ever participated in a clinical trial,” reported Khilen Patel, MD, of the Medical College of Georgia at Augusta University, in Augusta, Georgia.

Access to gynecologic oncology specialists varies dramatically across the United States, and up to 15% of women live in areas with limited access; an estimated 7,663 women with gynecologic cancers live in areas with low or no access to expert care. This contributes importantly to disparities in access to standard-of-care treatment for ovarian cancer, Dr. Patel said.

There is some evidence that racial disparities in ovarian cancer disappear in clinical trial populations, but nationally, as few as 6% of all participants in federally funded clinical trials are racial minorities, Dr. Patel noted.

Dr. Patel and colleagues sought to assess how clinical trial participation affects racial disparities in survival among women with advanced or recurrent EOC.

Of 236 patients with advanced or recurrent EOC, 145 (61.4%) were treated on a clinical trial while 91 (38.6%) did not participate in a clinical trial. At his institution, 24% of clinical trial participants were racial or ethnic minorities, Dr. Patel said. Patients who were racial minorities tended to be younger (median age, 56.5 years vs. 64 years for white patients) and to have more advanced-stage EOC.

Among women with advanced or recurrent EOC, the median overall survival (OS) was 71.4 months among white women and 24.5 months among minority women (hazard ratio [HR], 0.398; 95% CI, 0.216–0.732; P = .059), Dr. Patel reported.

In contrast, among women who participated in a clinical trial, the disparity in OS was much smaller: 53.5 months for whites vs. 50.9 months for minority patients (HR, 0.841; 95% CI, 0.505–1.401; P = .63, n.s.).

In multivariate analysis, OS was significantly greater for white patients who lived fewer than 25 miles from the treatment center (HR, 0.27; 95% CI, 0.098–0.768).