Ovarian Cancer in Black Women: What Residential Context Can Tell Clinicians About Survival

Residential context has a stronger association with survival for Black than white women with epithelial ovarian cancer (EOC), according to a study published online Aug. 10 in JAMA Network Open.

Francesmary Modugno, Ph.D., M.P.H., from the University of Pittsburgh School of Medicine, and colleagues conducted a retrospective, observational cohort study involving women aged 18 years or older diagnosed with EOC to examine whether there is an association of residential context with racial disparities in EOC survival. The study included 509 Black women and 2,035 white women.

What the Researchers Found

The researchers found that the likelihood of being diagnosed with EOC at a more advanced stage was increased for Black versus white women (68.0 versus 62.6 percent); Black women were less likely to have high-grade serous cancers (50.3 versus 53.2 percent). Worse overall survival was seen for Black women (adjusted hazard ratio [AHR], 1.45). Worse overall survival was seen in association with living in areas of greater social vulnerability (AHR, 1.20), with a significantly greater effect for Black versus white women (AHR, 1.77 versus 1.10); the hazard was 32.5 percent greater than expected from the main effects of the social vulnerability index (SVI) and race. Compared with white women residing in similar SVI areas, Black women residing in low and high SVI areas had significantly greater hazards of death (AHRs, 1.20 and 1.60, respectively). No pure mediation effect of SVI was seen on the race-mortality association, but 16.4 percent of the race-mortality excess relative risk was attributable to mediated interactions between race and SVI.

“We expected residential context to influence outcomes, but what surprised us was how much stronger the impact was for Black women,” Modugno said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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Why Residential Context Matters for Black Women With Ovarian Cancer

Black women with epithelial ovarian cancer already experience worse overall survival than white women. In this study, Black women had an adjusted hazard of death 45 percent higher than white women. Black women were also more likely to be diagnosed at an advanced stage.

Importantly, the researchers found that residential vulnerability had a stronger association with survival among Black women. Black women in both low- and high-SVI areas had higher mortality than white women living in comparable areas.

The study’s findings show that a neighborhood’s social conditions strongly impact ovarian cancer survival, and the negative effects are much harsher for Black women.

Social Determinants of Health Can Shape the Cancer Care Journey

In the study, researchers used the CDC/ASTDR Social Vulnerability Index (SVI) at the census-tract level, incorporating economic, social, household, racial/ethnic, housing, and transportation characteristics. Ultimately, these factors can influence access to high-quality cancer care.

Residential context can reflect barriers that can affect cancer care for Black women, including:

• Transportation and ability to consistently reach oncology appointments
• Access to high-quality cancer centers and gynecologic oncologists
• Ability to take time away from work or caregiving responsibilities
• Housing and financial instability
• Access to healthy food and other supportive resources
• Treatment delays or difficulty completing treatment
• Access to supportive and survivorship services

A patient’s ZIP code shouldn’t be treated as a proxy for individual behavior or adherence. Instead, it can prompt clinicians to ask what barriers may be affecting a patient’s ability to receive and complete care.

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What Clinicians Can Do to Address Barriers to Ovarian Cancer Care

The study provides insights into how the social determinants of health can influence a patient’s cancer outcomes.

While residential context is a broader issue that the healthcare system alone can’t address, there are approaches clinicians can take to help with earlier diagnosis and treatment of ovarian cancer for Black women.

These approaches can include:

• Screening for barriers earlier: Ask patients about transportation, treatment-related expenses, caregiving responsibilities, work obligations, and ability to attend frequent appointments.
• Connecting patients with navigation resources: Patient navigators, community health workers, and social workers may help patients address logistical barriers that could otherwise interfere with treatment.
• Looking beyond the individual patient: A patient missing appointments should not automatically be seen as nonadherent. Consider whether structural or socioeconomic barriers are contributing.
• Coordinating care: When appropriate, help connect patients to specialists and multidisciplinary cancer care, particularly when geography or transportation creates challenges.
• Implementing culturally responsive communication: For Black women, addressing concerns about discrimination, trust, communication, and previous healthcare experiences can be an important part of building an effective care relationship.
• Planning for survivorship from the beginning: Financial toxicity, transportation, mental health, caregiving responsibilities, and access to follow-up care can remain relevant long after initial treatment.

Final Thoughts

Researchers found that residential context appears to interact with race in ways that influence ovarian cancer survival, but improving a patient’s neighborhood circumstances alone may not eliminate the disparity. Providers need to recognize both the structural barriers and the individual experiences that can affect cancer care.

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