BACKGROUND:Despite the widespread adoption of minimally invasive surgery in the US, disparities in its use persist. One unexplored contributor is geographic access to robotic surgical systems. This study evaluates the geospatial association between: (1) Social Vulnerability Index (SVI) and open surgery rates, (2) availability of robotic systems and open surgery, and (3) open surgery rates in demographically similar areas with differing robotic access. STUDY DESIGN:Data from 6 sources were linked at the ZIP Code Tabulation Area (ZCTA) level to identify hospitals and to extract procedure modality, presence of robotic systems, and area characteristics. Regression analysis assessed the association between SVI and open surgery rates. Open rates were then compared between hospitals with and without robotic systems. Propensity score matching was used to compare open rates across matched ZCTAs by robotic access and SVI levels. RESULTS:Higher social vulnerability was associated with increased open surgery rates (estimate = 0.20; p < 0.01), with rates ranging from 18.3% in low-vulnerability areas to 32.7% in high-vulnerability areas. Among 3,446 eligible ZCTAs, 57% had at least 1 robotic system. ZCTAs without robotic systems had higher open surgery rates (42.9 vs 19.4 per 100 procedures; relative rate = 2.21; p < 0.01). This association remained significant after matching (relative rate = 1.66; p < 0.01), for the low-mid- and high-SVI strata, and 3 of the 5 procedures examined. CONCLUSIONS:When correcting for geographic variation, the availability of robotic surgery was associated with a decrease in open surgery rates.
BACKGROUND:Patient-reported outcomes (PROs) are critical in recurrent ovarian cancer, where symptom burden and quality of life (QOL) influence treatment decisions. Given limited psychometric validation of PROs in patients receiving modern targeted therapies, we conducted a comprehensive evaluation of the NCCN/FACT Ovarian Symptom Index-18 (NFOSI-18), including both Total and disease-related symptoms (DRS-P) subscale scores, and a single-item about side effect (GP5), to assess their reliability and validity in recurrent ovarian cancer. METHODS:Data were drawn from NRG Oncology trial GY004 (n = 489). Participants completed the NFOSI-18, EQ-5D-3L and EQ-VAS at baseline and every 12 weeks. Baseline and last QOL time points were analyzed to evaluate psychometric properties of the NFOSI-18 DRS-P and Total scores, and the GP5 item. Analyses included internal consistency reliability, convergent and known-groups validity, responsiveness to change, and meaningful change thresholds. RESULTS:The DRS-P and Total scales demonstrated good internal consistency (Cronbach's α = 0.72-0.87) and moderate convergent validity with EQ-5D VAS and Utility Index (r = 0.56-0.63). Strong known-groups validity was observed, with moderate-to-large effect sizes (0.44-1.05) across performance status categories. Score declines were greater in patients with stable or progressive disease compared to those with complete or partial response, supporting responsiveness to clinically meaningful change. Recommended change thresholds were 4-12 points (Total) and 3-8 points (DRS-P). CONCLUSIONS:The NFOSI-18 DRS-P and Total scales are reliable, valid, and responsive measures in recurrent ovarian cancer. These findings support their use as PRO endpoints in future ovarian cancer clinical trials.
