Page 189 - Read Online

Kaufman et al. J Cancer Metastasis Treat 2019;5:13 I http://dx.doi.org/10.20517/2394-4722.2018.25 Page 5 of 10
2
found that the risk of death from OC was higher in women with the greatest BMI (35-40 kg/m ) compared
2 [32]
with those of normal weight (BMI 18.5-24.9 kg/m ) . African American and Hispanic women have a
disproportionately higher rate of obesity and have higher BMI (> 40) which may correlate with a higher
incidence mortality of OC [16,27,28,33] . A correlation also exists between obesity and socioeconomic position,
suggesting that more overweight and obese people are from underserved populations with poorer access
[34]
to healthcare . In addition to limited access to quality healthcare, obese patients may be more difficult
to diagnose with OC due to greater difficulty in assessing vague symptoms and limited utility of current
diagnostic approaches in these patients. Studies indicate that women who were considered overweight and
[35]
obese had symptoms such as abdominal swelling and discomfort months before the diagnosis of OC .
Healthcare providers can impact meaningful change through education to patients of the positive impact of
a low inflammation diet. Similarly, patient education regarding weight loss through healthy diet and exercise
can meaningfully impact patient’s health and reduce risk factors for OC.

Patients with a limited English proficiency have lower health literacy rates, less access to healthcare systems,
[36]
and poorer outcomes . Many of these patients use ad-hoc medical interpreters, such as staff, friends or
family members, who are not officially licensed to serve as an interpreter for a clinical interaction. The use
of an ad-hoc interpreter leads to miscommunication and is ineffective and result in poor patient outcomes.
One study confirmed that the use of an ad-hoc interpreter leads to a higher rate of error than using no
[37]
[36]
interpreter at all . Schwei et al. reported that patients rarely, if ever, request interpreter services. Even
[38]
the use of trained medical interpreters may result in impaired physician-patient communication. Kamara et al.
analyzed 24 audio recordings of cancer genetic counseling consultations from 13 different patients and
six different counselors conducted in Spanish with the assistance of 18 telephone interpreters at two large
public hospitals [38,39] . The primary causes of impaired communication through the use of interpreters were
erroneous hypothetical explanations, and misinterpretation by the interpreter, resulting in a significant
departure from the shared-decision model of healthcare [37,38,40] . The interpretations did not assist patients in
their decision-making process. Furthermore, physicians found that even with the use of interpreters it was
difficult to understand the decision of a patient. There were instances in which interpreters did not interpret
a patient’s response or question, a marked departure from a high-quality mutual discussion, and a shared-
decision model of healthcare [36-38,40] . Therefore, patients often consented to the provider’s recommendations
regardless of their comprehension of the treatment plan and limiting patient autonomy. Low English
proficiency patients are more likely to have a limited health literacy and increased dissatisfaction with the
health system overall [36-38,40] . These data suggest that public health, social disparities, and language barriers
negatively impact outcomes in OC patients.

GEOGRAPHIC AND TRAVEL FACTORS THAT IMPACT OC PATIENTS
Disparities also exist in patients’ geographic environments, impacting patient outcomes. Patients from lower
socioeconomic communities have access to fewer clinics, with fewer resources and compromised diagnostic
[19]
capability [19,29] . Sakhuja et al. reported that African American OC patients lived in geographic areas that
had fewer oncology centers and fewer centers with ultrasound, and fewer subspecialists [1,5,19,29] . Statistics
have consistently shown that patients with OC are best treated by a gynecologic oncologist and that tertiary
care medical centers have the resources and capabilities to better serve these patients. Lack of access to
subspecialty care negatively impacts survival from OC. Hence, the likelihood of a patient presenting to a
physician with insufficient clinic resources is statistically much greater in a lower socioeconomic setting.
Moreover, OC patients who are presented to general hospital clinics have greater odds of late-stage diagnoses
and increased mortality rates than those who present to subspecialty clinics [18,19] .

[16]
Srivastava et al. reported that only 22% of Caucasian and 14% of African American OC patients would
be willing to drive more than 20 miles for treatment, which also correlates with data suggesting that
the larger the distance between a patient and their gynecologist, the greater the mortality rates [16,41,42] .
[43]
Guidry et al. surveyed 593 cancer patients in Texas, of which 38% of the Caucasians surveyed, 55% of