Role of neighborhood context in ovarian cancer survival disparities: current research and future directions

Abstract

Ovarian cancer is the fifth leading cause of cancer-associated mortality among US women with survival disparities seen across race, ethnicity, and socioeconomic status, even after accounting for histology, stage, treatment, and other clinical factors. Neighborhood context can play an important role in ovarian cancer survival, and, to the extent to which minority racial and ethnic groups and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment, these contextual factors may be a critical component of ovarian cancer survival disparities. Understanding factors associated with ovarian cancer outcome disparities will allow clinicians to identify patients at risk for worse outcomes and point to measures, such as social support programs or transportation aid, that can help to ameliorate such disparities. However, research on the impact of neighborhood contextual factors in ovarian cancer survival and in disparities in ovarian cancer survival is limited. This commentary focuses on the following neighborhood contextual domains: structural and institutional context, social context, physical context represented by environmental exposures, built environment, rurality, and healthcare access. The research conducted to date is presented and clinical implications and recommendations for future interventions and studies to address disparities in ovarian cancer outcomes are proposed.

Keywords: multilevel framework; ovarian cancer; race and ethnicity; social inequities; survival disparities.

Figure 1.. Multilevel framework for studying ovarian cancer disparities.

Adopted from Warnecke et al. 2008. The figure reflects the underlying hierarchy of factors, i.e., distal factors impact disparate health outcomes by various pathways via intermediate and proximal factors. Bulleted points refer to the concepts/measures examined in ovarian cancer research to date. Proximal factors are not the focus of this commentary.