Abstract
BackgroundDespite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood.Here we investigate if ultra short-term survival can be explained by patient characteristics or treatment pathways.MethodsA nested case comparison study was used to examine differences between patients with high grade serous ovarian/fallopian tube cancer who died within 100 days (n = 28) compared to a comparison group of patients matched for histology and including any survival greater than 100 days (n = 134).ResultsCases and comparison patients had similar ages, BMI, ACE-27, deprivation indices, and distribution of disease on CT. There were no significant delays in time to diagnosis or treatment (p = 0.68) between the groups.However, cases had lower serum albumin, haemoglobin and higher platelet counts than matched comparison patients (p < 0.0001) and a worse performance score (P = 0.006).ConclusionPatients who die rapidly after a diagnosis of ovarian cancer are only slightly older and have similar pre treatment frailty compared to patients whose survival approaches the median. However they do appear to undergo greater physiological compromise as a result of their disease.
Highlights
Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood
The National Cancer Intelligence Network in the United Kingdom (UK) identified a group of ultra short-term survivors (USTS) [3] and showed an association with age, emergency presentation and socioeconomic status, a finding confirmed by others [4, 5]
Between 2013 and 2015 inclusive, 208 patients were diagnosed with high grade serous ovarian cancer in our tertiary unit. 28/208 (13%) died within 100 days of diagnosis
Summary
Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood. There is a small but important group of women who suffer a very rapid decline, surviving less than 100 days who may be termed ultra short-term survivors (USTS). Hawarden et al BMC Cancer (2021) 21:378 combining both surgery and chemotherapy, and spanning over approximately 150 days, none of the USTS group, by definition, will complete treatment, and a proportion will never commence treatment at all The reasons behind this early death are poorly understood, but this group are important as they could potentially benefit from novel interventions. The National Cancer Intelligence Network in the UK identified a group of ultra short-term survivors (USTS) [3] and showed an association with age, emergency presentation and socioeconomic status, a finding confirmed by others [4, 5]. This study was not conducted within the context of a comprehensive universal care system such as the UK National Health Sevice (NHS)
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