Introduction: Ovarian cancer is the deadliest type of gynaecological cancer, with high inter- and intra-country variability in outcomes. Individuals with advanced stage ovarian cancer in Nova Scotia have the lowest 3-year survival (31.9%) in the country. This study aimed to identify prognostic factors impacting survival in Nova Scotia and explore potential inequities in survival and access to care from the point of diagnosis.

Methods: This population-based study included all women diagnosed with ovarian cancer in Nova Scotia from 2007-2016. Linked administrative datasets were used to collect disease, demographic, and health system data. Three equity factors (region, poverty and mental illness) and multiple clinical prognostic factors (e.g. stage and frailty) were assessed for their contribution to variations in survival using time to event models. Logistic regressions were used to assess inequities in access to specialist care.

Results: Survival disparities at the time of diagnosis were not significantly associated with equity factors (region, poverty or mental illness) but were instead explained by clinical prognostic factors like stage and frailty. Significant inequities in accessing specialist care were identified in one region, which greatly impacted survival. Around 25% of women were not assessed by a gyne-oncologist within 6 months of diagnosis, which occurred most often for those with unknown stage or sub-type, frailty, and those living in the northern zone. While survival was not associated with surgery location, a significant proportion (31%) did not undergo surgery, and demographic differences were observed between these groups.

Conclusion: Though we did not identify inequities in ovarian cancer survival by region, poverty or mental illness, these factors may indirectly influence outcomes by limiting access to specialist care. Targeted interventions are needed to ensure timely assessments by gyne-oncologists for all women in Nova Scotia.