Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors

Lacey Loomer, Kevin C. Ward, Evelyn A. Reynolds, Silke A. von Esenwein, Joseph Lipscomb

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: To examine ovarian cancer survivors’ adherence to evidence-based guidelines for preventive health care. Methods: A case-control, retrospective study of Medicare fee-for-service beneficiaries diagnosed with stage I, II, or III epithelial ovarian cancer from 2001 to 2010 using the Surveillance, Epidemiology, and End Results-Medicare database. Survivors were matched 1:1 to non-cancer controls from the 5% Medicare Beneficiary file on age, race, state of residence, and follow-up time. Receipt of flu vaccination, mammography, and bone density tests were examined in accordance with national guidelines. Adherence was assessed starting 1 year after cancer diagnosis, across 2 years of claims. Interaction with the health care system, including outpatient and cancer surveillance visits, was tested as a potential mechanism for receipt of services. Results: 2437 survivors met the eligibility criteria (mean age, 75; 90% white). Ovarian cancer survivors were more likely to be adherent to flu vaccination (5 percentage points (pp); < 0.001) and mammography guidelines (10 pp.; < 0.001) compared to non-cancer controls, but no differences were found for bone density test guidelines (− 1 pp.; NS). Black women were less likely to be adherent to flu vaccination and bone density tests compared with white women. Women dually eligible for Medicare and Medicaid were less likely to be adherent compared to those without such support. Adherence was not influenced by measures of outpatient visits. Conclusion: Ovarian cancer survivors are receiving preventive services with the same or better adherence than their matched counterparts. Minority and dual-eligible survivors received preventive services at a lower rate than white survivors and those with higher income. The number of outpatient visits was not associated with increased preventive health visits. Implications for Cancer Survivors: Ovarian cancer survivors are receiving adequate follow-up care to be adherent to preventive health measures. Efforts to improve care coordination post-treatment may help reduce minority and low SES disparities.

Original languageEnglish (US)
Pages (from-to)512-522
Number of pages11
JournalJournal of Cancer Survivorship
Issue number4
StatePublished - Aug 15 2019
Externally publishedYes

Bibliographical note

Funding Information:
The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Healthcare Delivery Research Program, National Cancer Institute; the Office of Research, Development, and Information, CMS; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results (SEER) program tumor registries in the creation of the SEER-Medicare database. The authors thank Renjian Jiang for initial data compilation and for providing technical support for use of SEER-Medicare files.

Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.


  • Disparities
  • Ovarian cancer
  • Preventive care
  • Survivorship


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