Uncovering disparities for women with gynecologic cancers

A study by UNC Lineberger Comprehensive Cancer Center researchers and collaborators found that women with gynecologic cancer who were enrolled in both Medicaid and Medicare had worse outcomes compared with women enrolled in Medicare alone.

Uncovering disparities for women with gynecologic cancers click to enlarge Kemi Doll, MD, is a fellow in the UNC School of Medicine Division of Gynecologic Oncology. She's pursuing her master's in the UNC Gillings School of Global Public Health Department of Epidemiology. Photo Credit: UNC Gillings School of Global Public Health

A UNC Lineberger Comprehensive Cancer Center study has identified a higher risk of all-cause death for a population of lower-income women aged 65 years or older in North Carolina with gynecologic cancer.

The researchers say the findings, which were published recently in the journal Cancer, point to a need for targeted health interventions to address the disparity for this group.

“This study was a first step in our work to address gynecologic cancer disparities in North Carolina,” said study first author Kemi Doll, MD, a fellow in the UNC School of Medicine Division of Gynecologic Oncology. “Part of our strategy is to identify treatable, curable, sub-populations who are currently not doing as well, and then to investigate why, so we can design population-level interventions to close those gaps.”

The study was a population-based analysis of North Carolina Central Cancer Registry data for 4,522 women aged 65 years of age or older, of which 82 percent were enrolled in Medicare and 18 percent were dually enrolled. The researchers used the Integrated Cancer Information and Surveillance System (ICISS), a UNC Lineberger resource, to identify patients’ insurance status.

From their analysis, the researchers found that women above age 65 who are enrolled in Medicare as well as Medicaid, a federal and state program to help lower-income people pay for medical care, had a 34 percent higher odds of all-cause death after diagnosis with gynecologic cancer than women enrolled in Medicare alone.

“People tend to think of the Medicare population as fairly uniform, but it varies greatly based on insurance type,” Doll said. “The women in the low-income strata who have supplemental Medicaid do worse.”

The study suggests that access to health services may be playing a significant role in outcome disparities for women with gynecologic cancers, said Anne-Marie Meyer, PhD, faculty director of the UNC Lineberger Integrated Cancer Information and Surveillance System and a research assistant professor in the UNC Gillings School of Global Public Health Department of Epidemiology.

“This finding suggests that “access” is more than insurance coverage, and that there is a lot more we should be doing to optimize outcomes for these vulnerable populations,” said Meyer, who was the study’s senior author. “There are also not as many physicians practicing in this specialty, which may create greater access issues and subsequent disparities for women who suffer from these cancers. We look forward to continue working with Dr. Doll as she continues to explore these issues in the North Carolina population.”

In addition, the study also found that early-stage uterine and vulvar or vaginal cancers had the largest outcome disparities. Doll highlighted that finding as particularly significant because uterine and vulvar cancer can have higher cure rates.

According to the National Cancer Institute Surveillance, Epidemiology and End Results Program, vulvar cancer has a 71 percent five-year survival rate. The five-year survival rate for women with uterine cancer was 81.7 percent.

“We feel like interventions for that group of women in North Carolina could make a big difference,” Doll said.

Research is already ongoing to understand where treatment gaps might arise in the care for women with uterine cancer, Doll said.

“I am passionate about making sure that people talk about these ‘below the belt’ cancers,” she said. “These cancers have early presentations, early signs and symptoms that are often ignored by women. We want to improve outcomes of women with gynecologic cancer.”

The study was supported by the National Cancer Institute, the University Cancer Research Fund and the Foundation for Women’s Cancer.

In addition to Doll and Meyer, study authors include: Ke Meng, PhD, research data statistical analyst at UNC Lineberger, Ethan M. Basch, MD, MSc, director of the UNC Lineberger Cancer Outcomes Research Program and associate professor of medicine and public health at the UNC School of Medicine; Paola A. Gehrig, MD, a UNC Lineberger member and associate professor and director of the UNC School of Medicine Division of Gynecologic Oncology; Wendy R. Brewster, MD, PhD, a UNC Lineberger member, associate professor in the UNC School of Medicine Department of Obstetrics and Gynecology and Division of Gynecologic Oncology and director of the Center for Women’s Health Research at UNC.