A Role of Multilevel Healthcare Access Dimensions in Ovarian Cancer Disparities

ABSTRACT Ovarian cancer accounts for more deaths than any other cancer of the female reproductive system. In 2021, there were 21,410 new cases of OC and 13,770 deaths. Remarkable progress has been made in ovarian cancer treatment, resulting in a 33% decline in mortality in the past few decades; unfortunately, equitable

access to these therapies remains a challenge. While survival rates improved from 40% to 47% among non- Hispanic (NH) White women, survival has stagnated at 35% for NH-Black women. A well-established predictor of the ovarian cancer survival disparity is lack of access to quality treatment. In analysis of the SEER-Medicare

database between 2008-2015, only 14% of NH-Black ovarian cancer patients received guideline-concordant surgery and full cycles of recommended chemotherapy, contributing to poor survival. There is also growing recognition of the enduring impact of structural racism on health outcomes. Yet only a handful of studies have

examined structural racism in relation to OC disparities, and none have evaluated its contribution via healthcare access (HCA) domains, or via pathways that involve chronic stress associated with discrimination. In this R37 extension, we propose to build on the well-established ORCHiD (Ovarian Cancer Epidemiology,

Healthcare Access and Disparities) research infrastructure to examine longitudinal trajectories of HCA and investigate the individual and joint associations of structural (residential segregation) and interpersonal (experiences of discrimination) racism with HCA domains and ovarian cancer treatment and survival outcomes

in diverse patients. Our proposed extension substantially moves us towards translational impact by addressing key gaps in the literature regarding the mechanisms through which healthcare access domains impact OC disparities.