Disparities in access to gynecologic oncology visits among elderly patients with gynecologic malignancies

Despite evidence-based recommendations from SGO, ACOG, and NCCN, not all patients with gynecologic malignancies undergo consultation and management by a gynecologic oncologist. We aim to define the proportion of elderly patients with gynecologic cancers who had at least one visit with a gynecologic oncologist and evaluate for disparities in access to specialist care.

This is a retrospective cohort study of women with staged ovarian, uterine, and cervical cancer between 2000 and 2019 in the SEER Medicare database. Specialist visits were captured using Medicare Part B insurance claims. Descriptive statistics, t-tests, chi-squared tests, and univariate logistic regression were used to assess clinical and socioeconomic factors associated with in-person visits.

15,249 ovarian, 27,586 uterine, and 2647 cervical cancer patients were included in this study. There was an increase in the proportion of patients who saw gynecologic oncologists over time. Overall, 54.35% of ovarian, 61.49% of uterine, and 62.14% of cervical cancer patients saw a gynecologic oncologist for at least one visit. Those who were younger, living in census tracks with higher median income, and living in the Northeast were more likely to see a gynecologic oncologist. Visit access also varied by stage. Black and Hispanic patients with uterine cancer were more likely to see a gynecologic oncologist.

Less than two thirds of elderly patients with newly diagnosed gynecologic malignancies had a visit with a gynecologic oncologist. There were differences in access based on age, stage, geographic region, census track-based median income, and year of diagnosis in all subgroups.