Patients with epithelial ovarian cancer, one of the deadliest gynecologic cancers, who lived in disadvantaged neighborhoods had a worse chance of survival compared to those in more advantaged areas, according to a pilot study published in Gynecologic Oncology by University of Pittsburgh School of Medicine researchers.
Dr. Francesmary Modugno, photo courtesy of Rayni Shiring/University of Pittsburgh
“We need to pay attention to factors above and beyond the individual—like the environment in which a patient lives— that could impact their care,” said corresponding author Dr. Francesmary Modugno, professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Pitt and Magee-Womens Research Institute. “We must find ways to improve outcomes for people who do not come from well-resourced areas, and work as a society to fix the issues in under-resourced neighborhoods.”
Epithelial ovarian cancer (EOC) is a particularly aggressive form of cancer, with a five-year survival rate of about 50%. Despite advances in treatment, outcomes vary widely among patients, even after accounting for factors like disease stage and therapy type. The new study suggests that neighborhood-based social determinants of health could contribute to these outcomes.
To investigate the link between community factors and EOC outcomes, Modugno and her team analyzed data from 177 patients who were newly diagnosed with EOC and received treatment at UPMC Hillman Cancer Center between 2012 and 2022. Patients had a median age of about 65 years and all self-identified as white. They followed the patients over time to measure cancer recurrence and survival.
Using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI), which measures 16 indicators of social and environmental vulnerability across four categories—socioeconomic status, household composition, minority status and housing/transportation—the researchers ranked the neighborhood of each patient’s home on a scale from low to high vulnerability.
The analysis revealed a striking pattern: Patients living in neighborhoods with the highest social vulnerability had significantly worse survival than those in less vulnerable areas.
According to Modugno, there are several possible reasons for this pattern. For example, patients living in areas with limited access to public transport might have trouble getting to appointments and receiving treatment. Likewise, living in a neighborhood with greater poverty and higher unemployment might create an environment in which personal safety and employment take priority over caring for one’s health, leading to delays in diagnosis and treatment.
Stress, particularly that associated with living in highly socially vulnerable neighborhoods, can directly suppress the immune system’s ability to identify and destroy cancer cells, intensifying health disparities in already at-risk populations. In previous research, Modugno found that allostatic load—a marker of chronic lifetime stress—was associated with worse survival in patients with EOC.
“We see a great variability in how women respond to ovarian cancer therapy and in survival outcomes,” said Modugno. “Understanding these disparities requires us to look beyond biological factors to the social contexts that shape health.”
Building on a growing body of evidence, the study highlights the importance of addressing social determinants of health to reduce health disparities. While earlier research has often focused on individual factors, such as income levels or race, the multidimensional approach offered by the SVI provides a more comprehensive understanding of how overlapping vulnerabilities and social context influence health outcomes.
According to Modugno, the results indicate an urgent need to integrate neighborhood vulnerability metrics into cancer care strategies. Policymakers and health care providers could use tools like the SVI to identify at-risk populations, tailor interventions and allocate resources more effectively. Addressing systemic issues such as housing instability, transportation barriers and economic inequities could create environments that promote healthier behaviors and better cancer outcomes.
Building on this work, Modugno plans to expand this research in larger and more diverse patient groups to further examine how social and biological factors interact to influence cancer progression and survival.
Fernanda Juarez Anaya is a Ph.D. candidate in the University of Pittsburgh Center for Neuroscience. She is participating in the UPMC Science Writing Mentorship Program.
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