National survey of ovarian carcinoma IV: Patterns of care and related survival for older patients

Abstract

Background. An analysis was conducted by the American College of Surgeons Cancer Commission evaluating the patterns of care of ovarian cancer patients diagnosed in 1983 and 1988. The purpose of this study was to investigate whether there was a difference in the care patterns of elderly ovarian cancer patients and its impact on survival. Methods. Data were collected from 25 consecutive patients whose disease was diagnosed initially at 904 participating hospitals with cancer programs in 1983 and 1988. The survival and care of patients greater than or equal to 80 years of age were compared to those less than 80 years of age. Results. Of the 12,316 patients evaluated, 1,115 were 80 years or older. A significant reduction in survival was noted among patients 80 years and older as compared to their younger counterparts (P = 0.03–0.00001). The 5‐year survivals were: stage I, 89% versus 79%; stage II, 58% versus 40%; stage III, 25% versus 11%; and stage IV, 13% versus 3%, respectively, for those less than 80 years old as compared to those greater than or equal to 80 years old. Most elderly ovarian cancer patients were cared for by nononcologists such as general surgeons (31%) and obstetricians/gynecologists (29%). As a group, older patients had fewer total abdominal hysterectomies, bilateral salpingo‐oophorectomies, and omentectomies than their younger counterpart (P < 0.00001). As further evidence for a less aggressive surgical approach, the optimal tumor debulking rates of women greater than or equal to 80 years were significantly less than those of younger patients (P < 0.001). There was no significant increase in anesthesia complications between age groups. Generally, older patients are less likely to receive adjuvant chemotherapy than younger patients (42% versus 69%, P < 0.0001). Conclusion. It appears that conservative treatments contributed to the decreased survival of older ovarian cancer patients.

Chemotherapy Completion in Elderly Women With Ovarian, Primary Peritoneal or Fallopian Tube Cancer—An NRG Oncology/Gynecologic Oncology Group Study

“…Less surgery is being performed in the oldest of old [31][32][33]. Patients receiving neoadjuvant chemotherapy do not always eventually receive surgical debulking [34].…”

Improving outcomes for older women with gynaecological malignancies

“…It has been consistently shown that increasing age is associated with lower rates of referral to oncology specialists, lower rates of cytoreductive surgery and lower rates of optimal cytoreduction [31][32][33][34]. Neoadjuvant chemotherapy (NACT) with interval debulking surgery has been shown to be associated with higher rates of optimal cytoreduction, lower perioperative morbidity and mortality rates than primary debulking surgery [35,36].…”

Doublet Chemotherapy in the Elderly Patient With Ovarian Cancer

“…Advanced chronologic age is often an obstacle to enrollment in a clinical trial [43] or receipt of optimal treatment [9,36,39,92]. However, the older patient subgroup is not homogenous and life expectancy differs within the same age groups in an elderly population [93].…”