Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Issue 24 (15th August 2019)

• Record Type: Journal Article
• Authors: Mullins, Megan A.; Peres, Lauren C.; Alberg, Anthony J.; Bandera, Elisa V.; Barnholtz‐Sloan, Jill S.; Bondy, Melissa L.; Funkhouser, Ellen; Moorman, Patricia G.; Peters, Edward S.; Terry, Paul D.; Schwartz, Ann G.; Lawson, Andrew B.; Schildkraut, Joellen M.; Cote, Michele L.
• Is Part Of: Cancer. Volume 125:Issue 24(2019)
• Page Start: 4442
• Page End: 4451
• Publication Date: 2019-08-15
• Subjects: access to care -- ovarian cancer -- perceived discrimination -- prolonged symptoms -- racial disparity; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32451
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Discrimination and trust are known barriers to accessing health care. Despite well‐documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods: Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case‐control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom‐specific duration), and it controlled for access‐to‐care covariates and potential confounders. Results: Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1‐unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22‐2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66‐1.11). Conclusions: Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted. Abstract : Racial disparities throughout the ovarian cancer care continuum are well established and cannot be explained by traditional access‐to‐care determinants alone. These results suggest interpersonal barriers such as everyday discrimination may contribute to these disparities and warrant further investigation.