Background: Differential access to quality care is associated with racial disparities in ovarian cancer (OC) survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, i.e., primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. Methods: We analyzed data for OC patients diagnosed from 2008-2015 in the SEER-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. Results: The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery (RR: 0.83, 95% CI: 0.70-0.98); the observed association was attenuated after adjusting for healthcare affordability and availability (RR 0.91, 95% CI 0.77-1.08). Dual enrollment in Medicaid and Medicare compared to Medicare only was associated with lower likelihood of receiving surgery (RR: 0.86, 95% CI: 0.76-0.97) and systemic therapy (RR: 0.94, 95% CI: 0.92-0.97). Receiving treatment at a facility in the highest quartile of OC surgical volume was associated with higher likelihood of surgery (RR: 1.12, 95% CI: 1.04-1.21). Conclusions: Racial differences were observed in OC treatment quality and were partly explained by multiple HCA dimensions. Impact: Strategies to mitigate racial disparities in OC treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.

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