L. Stafman1, I. Maizlin1, K. Gow2, M. Goldfarb3, J. G. Nuchtern4, M. Langer5, S. Vasudevan4, J. Doski6, A. Goldin2, M. Raval7, E. Beierle1 1University Of Alabama,Birmingham, Alabama, USA 2University Of Washington,Seattle, WA, USA 3Providence Saint John’s Health Center,Santa Monica, CA, USA 4Baylor College Of Medicine,Houston, TX, USA 5Maine Medical Center,Portland, ME, USA 6University Of Texas Health Science Center At San Antonio,San Antonio, TX, USA 7Emory University School Of Medicine,Atlanta, GA, USA
Introduction:
Dysgerminoma accounts for two thirds of ovarian malignancies in adolescents and young adults (AYAs). Survival rates for Stage I dysgerminomas are excellent. Because dysgerminoma primarily affects females of childbearing age and younger, treatment must consider future fertility. Since socioeconomic factors have proven to be barriers in the receipt of conservative treatment in other cancers (e.g. breast-conserving therapy in breast cancer), we aimed to evaluate whether similar socioeconomic disparities exist in the receipt of fertility-sparing (FS) vs. non-fertility-sparing (NFS) surgery for Stage I dysgerminoma in AYA women.
Methods:
The National Cancer Data Base (NCDB) was used to identify all AYA females (14-39 years old) with dysgerminoma from 1998 to 2012, who were then stratified based on stage at presentation. Three socioeconomic surrogate variables were identified – insurance type, median income in the patient’s ZIP code, and percent of people with no high school degree in the patient’s ZIP code. NFS surgery was defined as any procedure including bilateral oophorectomy and/or hysterectomy. FS surgery was defined as unilateral or partial oophorectomy. Within each stage, χ 2 and t-tests were used to compare rates of FS and NFS within each variable, controlling for age and race.
Results:
Of the 1247 AYA females with ovarian dysgerminoma in the NCDB, 687 (55.1%) had Stage I disease. Amongst these Stage I patients, there was a significant difference in surgical therapy (FS vs. NFS) for all three socioeconomic surrogate variables (Table 1). The uninsured had higher NFS rates (30.2%) compared to those with government (21.3%) or private (19.3%) insurance (p=0.036). Those living in ZIP codes in the lowest median income quartile had almost twice the rate of NFS operations (31.4%) compared with those in the highest median income quartile (17.4%). For those living in the least educated regions, 23.6% underwent NFS surgery whereas only 14.5% underwent NFS surgery in areas with the most educated population (p=0.027). There was no significant difference in rates of FS and NFS surgery based on race (p=0.17). Additionally, there was no significant difference between FS and NFS rates based on the same variables in Stage II-IV dysgerminomas.
Conclusion:
Based on all three socioeconomic surrogate variables – insurance, income, and education – AYA women from lower socioeconomic strata were more likely to undergo NFS surgery for Stage I dysgerminoma than those in higher strata. Given that most dysgerminomas are diagnosed at Stage I, it is concerning that a disparity exists affecting future fertility. These data provide an opportunity for education and quality improvement for the treatment of this population.
