Psychosocial Stress Exposures and Advanced Disease at Ovarian Cancer Diagnosis

IntroductionRacial disparities in ovarian cancer outcomes persist even after accounting for clinical and treatment factors. Psychosocial stressors, including discrimination and perceived stress, may contribute through behavioral and biological pathways, but their associations with advanced disease at diagnosis remain understudied.MethodsWe conducted a cross-sectional analysis of 451 women (69 Black, 382 White) with ovarian cancer enrolled in the Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD) study, a population-based study recruiting from state cancer registries across seven US states between March 2021 and August 2024. Participants completed surveys assessing everyday discrimination (EOD) and perceived stress (PSS-4); disease characteristics were obtained from cancer registry records. Logistic regression models assessed associations between psychosocial stressors and late-stage disease (FIGO stage IV) or Type II epithelial histology.ResultsOverall, 12.4% reported EOD in ≥3 domains while 11.5% reported high PSS-4 scores. Black women reported significantly higher discrimination levels; 49% reported discrimination in 3+ domains versus 6% of White women. PSS-4 scores did not differ by race. In adjusted models, higher EOD score was associated with 42% increased odds of late-stage disease (OR 1.42, 95% CI: 0.64, 2.98) and higher PSS-4 score with 32% increased odds (OR 1.32, 95% CI: 0.56, 2.94), though these associations were not statistically significant. Discrimination while receiving service in stores or restaurants showed a nominally significant association with late-stage diagnosis (adjusted OR = 2.11, 95% CI: 1.05-4.25), though this did not survive correction for multiple testing.ConclusionsBlack women with ovarian cancer experience substantially higher levels of racial discrimination, but these exposures were not consistently associated with advanced disease at diagnosis. A nominally significant domain-specific association with service-setting discrimination warrants investigation in larger, prospective studies. These findings suggest that specific discrimination experiences may represent a pathway through which psychosocial stress contributes to ovarian cancer disparities.