Association of digital access with survival in gynecologic cancers: Analysis of the surveillance, epidemiology, and end results (SEER) database.

Authors

Julia Chalif, Laura M Chambers, Caitlin E Meade, Molly Morton, Julia Sakach, Qinhan Hu, Simran A Kanal, David M O'Malley, Floor J Backes, Ashley S Felix

Published in

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. Pages 104960. Aug 10, 2026. Epub Aug 10, 2026.

Abstract

Gynecologic cancers are marked by racial and socioeconomic disparities. As oncology care becomes increasingly digital, inequities in broadband and digital resources may exacerbate survival gaps. This study evaluated associations between digital inequity, measured by the Digital Divide Index, and survival among patients with gynecologic cancers.
Using the Surveillance, Epidemiology, End Results Research Plus Specialized data, we identified adults diagnosed with cervical, ovarian, or uterine cancer from 2017-2021. County-level Digital Divide Index scores, calculated from American Community Survey indicators and Ookla Speedtest broadband data, were obtained, categorized in quartiles (Q1 = lowest inequity; Q4 = highest inequity) by year and cancer site, and linked to patients. Multivariable-adjusted Cox regression estimated hazard ratios and 95% confidence intervals for cancer-specific survival. Interaction terms assessed effect modification by key covariates.
Among 79,262 patients (11,374 cervical, 17,044 ovarian, 50,844 uterine), those living in counties with higher digital disadvantage were more likely to be Black, reside in rural and lower-income regions, and receive surgery less often. No association between digital disadvantage and cancer-specific survival was noted in the overall study population; however, among patients with cervical cancer (Q3 vs Q1 hazard ratio = 1.17, 95% confidence interval, 1.03 to1.33) and gynecologic cancer patients diagnosed before age 50, higher digital disadvantage (Q3 vs Q1 hazard ratio, 1.33, 95% confidence interval, 1.15 to 1.54; Q4 vs Q1 hazard ratio, 1.17, 95% confidence interval, 1.01 to 1.37) was associated with worse cancer-specific survival.
These findings suggest that digital inequities may contribute to site- and age-specific disparities in gynecologic cancer survival, underscoring the need to address barriers to digital access as part of efforts to improve cancer outcomes.

PMID:
42692955
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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