Under-Treatment of Older Patients with Newly Diagnosed Epithelial Ovarian Cancer Remains an Issue.

Abstract

Simple SummaryCancer treatment and survival in older women is topical and important in an era where the proportion of older adults being treated for cancer in the clinic is rising. As survival outcomes in older women continue to lag behind those of younger and middle-aged women, further investigation is required into current treatment practices to identify target areas to address this deficit. We present treatment patterns, tolerance and outcomes of 280 women aged 65 and above treated for newly diagnosed ovarian cancer at two UK cancer centres between 2009 and 2015. We demonstrate that older women continue to receive lower rates of standard care first line therapy. When adjusted for stage at diagnosis, surgical outcome and chemotherapy given, age was not an independent risk factor for poorer overall survival.Older women with ovarian cancer have disproportionately poorer survival outcomes than their younger counterparts and receive less treatment. In order to understand where the gaps lie in the treatment of older patients, studies incorporating more detailed assessment of baseline characteristics and treatment delivery beyond the scope of most cancer registries are required. We aimed to assess the proportion of women over the age of 65 who are offered and receive standard of care for first-line ovarian cancer at two UK NHS Cancer Centres over a 5-year period (December 2009 to August 2015). Standard of care treatment was defined as a combination of cytoreductive surgery and if indicated platinum-based chemotherapy (combination or single-agent). Sixty-five percent of patients aged 65 and above received standard of care treatment. Increasing age was associated with lower rates of receiving standard of care (35% > 80 years old versus 78% of 65–69-year-olds, p = 0.000). Older women were less likely to complete the planned chemotherapy course (p = 0.034). The oldest women continue to receive lower rates of standard care compared to younger women. Once adjusted for Federation of Gynaecology and Obstetrics (FIGO) stage, Eastern Cooperative Oncology Group (ECOG) performance status and first-line treatment received, age was no longer an independent risk factor for poorer overall survival. Optimisation of vulnerable patients utilising a comprehensive geriatric assessment and directed interventions to facilitate the delivery of standard of care treatment could help narrow the survival discrepancy between the oldest patients and their younger counterparts.