Ovarian cancer is the deadliest of all gynecologic cancers and the ninth most common cancer among women. All women are at risk of developing ovarian cancer. Its symptoms are subtle, difficult to diagnose and often misdiagnosed because they mimic other less-threatening problems. As a result, many women are diagnosed in the later stages of the disease when survival rates are poor. This year, approximately 22,000 women will be diagnosed with ovarian cancer in the United States and almost 16,000 women will die from the disease.
For all of these reasons, a woman with ovarian cancer must have access to high quality care where she lives. Not only is high quality care critical to women's survival and well-being, how a state supports access to care illustrates its overall approach to any serious illness. This report card ranks all 50 states and the District of Columbia based on a selection of programs, policies, laws and regulations. Taken together, these mechanisms determine the extent to which a woman can access quality health care for ovarian cancer in reasonable proximity to her home.
We chose primarily to evaluate state laws because they provide the legal framework within which health care services are delivered. If a state's laws and associated programs are meaningful and robust-designed to meet the health needs of the state's population-they provide a pathway for effective, efficient health care. However, laws are not the only route through which states influence the care provided to seriously ill patients. States can establish regulations that transform laws into reality and articulate overarching policy regarding access to and quality of care.
Many of the mechanisms we used to rank states affect the overall health and well-being of all their citizens. We also considered laws relevant specifically to the care of ovarian cancer patients and survivors. For example, women with ovarian cancer must have prompt access to a gynecologic oncologist for the surgery that almost always is the first step in treating their disease. Therefore, we included regulations and laws pertaining to insurance coverage for referrals to specialists.
Some variables affecting the delivery of quality health care are outside the purview of state policy and law. Even in these areas, however, states can use their influence to advocate for effective and efficient care that meets quality standards. For example, states cannot require doctors to refer women with ovarian cancer to a specialist, but they can create policies that make it easier for women to seek specialized care. States also can publically recognize and applaud private efforts to provide support services for women with ovarian cancer and their families.
We looked within the states at activity that affects women with ovarian cancer, even if it is not directly provided by state law or programs. For example, prompt diagnosis continues to be a challenge for women with ovarian cancer. The Alliance's Survivors Teaching Students: Saving Women's Lives® program educates medical professional students about the risk factors and symptoms of ovarian cancer in order to facilitate prompt diagnosis. We looked at the saturation of these programs in each state's medical professional schools.
The passage of the Affordable Care Act (ACA) has already spurred major changes in the delivery of health care in the United States, making this a timely moment to explore how each state's laws meet at least minimal criteria for providing its citizens with access to quality cancer care. State laws remain relevant during implementation of the ACA. For instance, each state will determine its own essential benefits package, which is the minimum standard for insurance plans offered in the state.
Although our findings paint a bleak picture of states' attention to quality care for ovarian cancer patients, we also document opportunities for meaningful improvement. Our goal is to improve the care that women with this disease receive. Therefore, we have included the first comprehensive collection of sample laws and recommendations for their implementation that states can use to improve care.
In summary, Ovarian Cancer: A Call for State Action provides the first comprehensive look at the extent to which states meet specific criteria for promoting the delivery of effective, efficient care to women with ovarian cancer. This report card is based on the assumption that states can and do affect access to and quality of care for seriously ill people. Although current state laws often fail to meet women's needs, opportunities exist for significant improvement.
Thank you to Genentech and GlaxoSmithKline for supporting this project.
About the Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance works to advance the interests of women with ovarian cancer. We do so by advocating on behalf of women with this disease; promoting research that seeks an early detection test and improved treatments; improving health care practices; and raising public awareness of the risks and symptoms of ovarian cancer.