Psychosocial Stress Exposures and Advanced Disease at Ovarian Cancer Diagnosis.

内容摘要

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. What We StudiedWe examined whether stress and experiences of discrimination are connected to how advanced ovarian cancer is when women are first diagnosed. We surveyed 451 women with ovarian cancer (69 Black, 382 White) about discrimination in everyday life and their stress levels. To our knowledge, this is one of the first studies to examine these connections in a diverse group of ovarian cancer patients.What We FoundBlack women reported dramatically higher levels of discrimination than White women. Nearly half (49%) reported discrimination in three or more areas of daily life, compared to only 6% of White women, with the largest gaps in getting service in stores or restaurants, at work, and in housing. This represents a substantial, largely invisible burden that Black women carry alongside their cancer diagnosis. We did not find consistent, statistically significant links between discrimination or stress and later-stage diagnosis overall. Women who experienced discrimination while getting service in stores or restaurants appeared more likely to be diagnosed at a later stage, but this connection was no longer statistically reliable once we accounted for the many comparisons we made. Other measures of discrimination and stress showed similar trends that were not strong enough to confirm.Why This MattersThis study documents that Black women with ovarian cancer face dramatically higher discrimination in their daily lives. While discrimination in public settings may be linked to later-stage diagnosis, larger studies are needed to confirm these patterns and clarify how chronic stress might shape cancer outcomes.