| dc.description.abstract | Introduction: Globally, ovarian cancer is the 6th most common type of cancer among women. Though advancements in early detection and treatment practices continue to improve cancer outcomes, only about half of women who are diagnosed with ovarian cancer will survive 5 years. There is large inter- and intra-country variability in ovarian cancer outcomes. Individuals diagnosed with advanced stage cancer in Nova Scotia have a 3-year net survival of 31.9%, which is the lowest in the country. This study aimed to identify prognostic factors impacting survival throughout Nova Scotia, and to investigate if there is evidence of inequities in both survival and access to care from the point of diagnosis, based on geographical regions, poverty, mental illness, or continuity of care. Methods: This study utilized a population-based retrospective design of all women diagnosed with ovarian cancer in Nova Scotia from Jan 1, 2007 to Dec 31, 2016. Cancer registry, clinical, and administrative health data were linked to gather data on individual, tumor, treatment, regional, and health system characteristics. Both illegitimate and legitimate prognostic factors potentially contributing to regional variations and inequities in ovarian cancer survival were assessed using time to event (i.e., survival analyses) techniques. Logistic regression models were used to determine which of these factors were associated with inequities in access to specialist care, including surgery at a tertiary care hospital and assessment by a gyne-oncologist within 6 months of diagnosis. Results: This study found no regional differences in survival across Nova Scotia. Furthermore, it revealed that disparities in illegitimate prognostic factors do not appear to be significantly associated with survival outcomes at the time of diagnosis. Instead, survival variations were primarily attributed to legitimate prognostic factors, such as cancer stage, subtype, comorbidities, and frailty. However, notable inequities were identified in accessing specialist care, which substantially influenced survival time. Just under one-quarter of the study population were not assessed by a gyne-oncologist within 6 months of diagnosis. While survival was associated with surgery location, a significant proportion of individuals did not undergo surgical intervention, and demographic differences were observed between these groups. Conclusion: Though inequities do not appear to be contributing to differences in ovarian cancer survival at the time of diagnosis within Nova Scotia, they may indirectly influence outcomes by limiting access to specialist care. This highlights the need for targeted interventions and policy change at the system level to ensure that all women in Nova Scotia are assessed by gyne-oncologists in a timely manner, to ensure they can choose the most appropriate management strategy and potentially have an improved chance at survival. | en_US |
