Worldwide barriers of optimal surgical care provision in advanced ovarian cancer

Ovarian cancer (OC) remains one of the most challenging gynecological malignancies to cure, despite recent advances in treatment. Disparities in the diagnosis, management, and survival of OC exist worldwide and addressing them remains an ongoing challenge. The highest burden of OC is projected to be in women living in low- and middle-income countries, where mortality rates are also disproportionately higher. Maximal effort cytoreduction paired with maximal effort systemic therapy followed by maintenance therapies remain the cornerstones of treatment for OC. Disparities are twofold: first, due to challenges with systemic therapy; and second, due to variations in surgical care, especially for advanced disease. While the goals of surgery remain unchanged, the radicality of cytoreductive resections and variation in practices worldwide have increased. The provision of surgical care for OC patients faces numerous challenges broadly categorized into three main areas: health system barriers; patient-related barriers; and physician-related barriers. Health system challenges include the lack of centralized cancer care, scarcity of resources, and inadequate funding. Patient-related obstacles include disparities in patient education, comorbidities, socioeconomic factors, and underrepresentation of certain ethnicities in clinical trials. Physician-related barriers encompass suboptimal surgical training, limited access to educational resources, inconsistent adherence to guidelines, limited use of a multidisciplinary team and overall differences in philosophy, ethos, and surgical tradition. Addressing and overcoming these barriers is essential to ensure equitable access to high-quality surgical care for OC patients worldwide. The aim of the present review was to further explore these global challenges while also highlighting potential strategies to reduce disparities in women's health care.