Gynecol Oncol

ObjectiveUp to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care.MethodsWe utilized a retrospective cohort created through extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18\u201389 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010\u20132012 in Kansas, Missouri and Iowa by rurality.ResultsRural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24\u20130.58) and referral to a specialist (OR 0.37, 95% CI 0.23\u20130.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26\u20131.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to 64 1cm.ConclusionThere is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.CC999999/ImCDC/Intramural CDC HHSUnited States/P30 CA086862/CA/NCI NIH HHSUnited States/P30 ES005605/ES/NIEHS NIH HHSUnited States/T32 GM007337/GM/NIGMS NIH HHSUnited States