Treatment decision-making in elderly women with ovarian cancer: an age-based comparison

Abstract

ObjectiveTo investigate treatment choices and outcomes in women with ovarian cancer, comparing elderly (≥75 years) and younger patients (<75 years).MethodsA single-center retrospective analysis of patients diagnosed with ovarian cancer between 2010 and 2015. The initial treatment plan and course of treatment were extracted from medical files.ResultsOf 128 included patients, 34% were aged ≥75 years. The initial treatment plan consisted of the combination of cytoreductive surgery and platinum-based doublet chemotherapy (ie, standard treatment) in only 10% of the elderly patients with an indication for this treatment. 5% of these patients completed this treatment without adaptations (compared with 85% and 48%, respectively, in younger patients). 38% of the elderly patients with an indication for cytoreductive surgery and chemotherapy received best supportive care only. Patient preference was an important reason to withhold standard treatment. Surgery- and chemotherapy-related complications and hospital admissions did not differ between groups. Median survival was lower in the elderly (p=0.002) and in patients receiving best supportive care (p<0.001).ConclusionsElderly patients were less frequently treated in accordance with the treatment guideline. To select those older patients who may benefit from (adapted) treatment is challenging. Future studies should evaluate determinants associated with treatment completion to improve outcomes in this vulnerable population.

Shared decision making in gynaecological oncology; a challenge in an ageing population

“…The effect of this was illustrated in an ovarian cancer study, in which only 10% of patients aged over 75 years received best practice care according to guidelines (although the degree of patient involvement in these decisions was not specified). 9 This disconnect is acknowledged in NHS England's Cancer Strategy, which advocates a need to assess integrated pathways for older cancer patients, as well as better outlining the role of geriatricians and their input into the MDT. 10 What can comprehensive geriatric assessment offer?…”

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

“…These authors found that the CGA affected treatment decisions in a percentage of cases ranging between 21% and 49% [23][24][25][26]. Other studies have shown that incorporating the CGA in the management of older patients with cancer (i) improves clinical outcomes by helping select the most appropriate therapy [27], (ii) promotes the inclusion of patient preferences in the decision-making process [28][29][30], (iii) improves communication between oncologists and patients [28][29][30], (iv) reduces the risk of over-and undertreatment [31], (v) enhances treatment tolerance and completion [32] and (vi) predicts the frequency of hospitalisation and long-term care for older cancer survivors [33].…”

Personalised treatment for older adults with cancer: The role of frailty assessment

“…This loss of resilience may mean the difference between being independent in the aftermath of treatment, or becoming dependent so that hospitalisation or full-time care are now necessary. The patient's treatment decision may thus be impacted by such an outcome, as demonstrated in some studies to date [26,27].…”