By: Annette McElhiney
For 20 years teaching Literature and Women’s Studies courses in college, I recognized March as Women’s History month and African American History month. Having watched some of the 2016 presidential debates, I’ve been repulsed by the Xenophobic and angry complaints about political correctness or inclusion. As a 75 year-old white survivor of ovarian cancer writing this blog, I find myself asking, 1. Do women with ovarian cancer, a rare disease affecting 1 in 67 women (but a deadly fast-moving disease and the only cancer limited to women) get the same amount of funding for research as does the more common prostate cancer (a slow-moving and, usually, less lethal cancer of men)? 2. Do women from different races, sexual orientation, classes and ages have equal access to ovarian cancer treatment and increasing survival? Sadly, what I find is that the ISMS- sexism, racism, classism, lesbianism, and ageism – are continuing to impact the quality and quantity of life after ovarian cancer. I HOPE to change that and invite you to join me!
Most cancers don’t discriminate in terms of gender or race — gastric, colon, liver, brain, breast, skin or brain. Some cancers have made great leaps ahead in terms of funding and research, e.g. breast, skin and colon. But note what happens when you look at funding for prostate cancer (a slow-moving cancer) and ovarian cancer (one that can be very deadly as it moves quickly and recurs again and again).
In just 2013, prostate cancer, received $255,612,921 as opposed to ovarian cancer, which only received $100,558,561. I can hear Anti PC folks saying, “Oh no! Here is yet another woman whining about how women are discriminated against in health care and women of color particularly.” Bring them on! I believe every ovarian cancer survivor has earned the right to complain loudly and act assertively to increase funding for this dreadful disease that strikes roughly 22,000 women each year and kills 14,000 of them.
According to the National Ovarian Cancer Alliance, only about 37 percent of women receive the standard of care, (debulking surgery, proper staging, and 6 rounds of intravenously and/or intraperitoneal chemotherapy) delivered by experienced gynecologists and oncologist, not a general surgeon or an obstetrician and gynecologist. Where you live and your proximity to surgical specialists who have performed many such procedures greatly affects your survival. Sometimes general surgeons or gynecologists whom we may have seen for years will reassure patients and their families that they’ve done this procedure many times before. Obviously, some of us have been taught not to question our doctors and because we don’t want to insult them, we allow them to do the surgery rather than traveling further away seeking an opinion from an expert.
“A gynecologic oncologist is a subspecialist who specializes in treating women with reproductive tract cancers.”
However, according to the National Ovarian Cancer Research Fund, one should seek and find a gynecologist and oncologist to do the surgery for the following reasons:
- Gynecologic oncologists are initially trained as obstetrician/gynecologists and then undergo three to possibly more than five years of specialized education in all of the effective forms of treatment for gynecologic cancers (surgery, radiation, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancers.
- Gynecologic oncologists are five times more likely to completely remove ovarian tumors during surgery.
- Eighty percent of ovarian cancer patients receive inadequate surgical debulking–the removal of tumor tissue during surgery–and staging when done by non-gynecologic oncology surgeons.
- Survival rate and outcomes for women with ovarian cancer vastly improve with gynecologic oncologists.
- For those women with ovarian cancer who live in rural areas that may not have a gynecologic oncologist at a local hospital, her care can be supervised by a gynecologic oncologist at a major medical center who has relationships with medical oncologists in surrounding areas to provide the chemotherapy treatment.
In 2012, Dr. Robert Bristow a gynecologist and oncologist at University of California, Irvine said, “Poor women and African Americans with ovarian cancer are less likely to receive the highest standards of care, leading to worse outcome than among white and affluent patients.”
Continuing he says, “Not all women are benefiting equally from improvements in ovarian cancer care… The reasons behind these disparities are not entirely clear, which is why we need additional research.”
He and his colleagues showed that, “five-year survival rates varied significantly. Improvement in ovarian cancer care is measured in length of survival after diagnosis rather than a “cure” rate.”
“The rate for white women meeting NCCN standards was 41.4 percent, compared with 33.3 percent for African American women.” Among those whose care did not meet NCCN standards, the rate for white women was 37.8 percent, compared with 22.5 percent for African American.”
Bristow continued by saying, “women on Medicaid or those with no insurance had a 30 percent increased risk of death. Poor women – defined as having an annual household income of less than $35,000 – had worse survival rates regardless of race.”
He suggested, “the effects of race and socioeconomic status are cumulative and that some combination of other medical conditions, poverty, culture and social injustice accounts for the majority of observed disparities.”
In addition, according to the LBGT cancer network, lesbian women have greater risk for ovarian cancer. They write:
- Numerous studies have shown that taking birth control pills decreases a person’s risk of developing ovarian cancer.
- Lesbian are less likely to have used birth control pills.
- Pregnancy and breastfeeding, especially before age 30, have been shown to reduce the risk for ovarian cancer. Lesbians are less likely than heterosexual women to have biological children.
- As a group, lesbians have a higher BMI (Body Mass Index) than heterosexual women.
- Lesbians are more likely to smoke cigarettes or have used tobacco in the past.
- Lesbians are less likely to get regular medical/gynecological care than heterosexual women.
I would also add that, too often they must fight to have both health insurance shared between partners and also access to providing physical and emotional support to their loved ones if hospitals do not recognize gay marriage rights.
Finally, a 2013 study by the NCBI done in Europe suggests that one-third of ovarian cancer patients are 70 years or older. It concludes, “Elderly patients with ovarian cancer are often treated less radically. Their outcome is impaired despite no consistent prognostic effect of age itself. Biological age and functional status should be considered before individualized treatment plans are defined.”
Why are older women treated less aggressively? Many physicians have theorized that older women are not able to tolerate either aggressive surgery or chemotherapy. Sometimes this means they give chemo prior to surgery so that the tumor load, and, therefore, length of surgery, will be shorter. Even though complete debulking relates to better overall survival, some elderly women came out suboptimally debulked.
Certainly, if an older survivor has had other major health issues prior to her diagnosis, these previous suppositions may apply. The less fit the patient, the greater chance of morbidity after surgery and treatment. But, each woman diagnosed needs to be carefully assessed to her level of general health before determining the aggressiveness of surgery and chemo.
Thus this March, in honor of American Women’s History Month and African American History Month, I’ve chosen to write about the unequal access to good health care as well as uneven treatments offered. Perhaps each of us who are an advocate should make a resolution to get rid of the “ISMS” in ovarian cancer care. I plan on fighting for the rights of all women regardless of race, class, or age. As an elderly white woman, I’ve had terrific care for reasons not always available to other or because my son knew lots about the treatment of it. Therefore, as a 7.5-year survivor in remission, I pledge to do all I can to extend that same kind of care to all ovarian cancer survivors. Please join me!
ovariancancersupport 