Approximately 1 in 5 women with ovarian cancer do not undergo surgery even though surgery is a standard component of treatment. Women who opt for surgery could live up to 4 times longer.1
The number of patients older than 75 years who do not undergo surgery is increasing, in particular among those with stage III or IV ovarian cancer. Approximately half do not undergo surgery and one-quarter receive no therapy at all.
“Though surgery isn’t right for every patient, we suspect that some women do not receive beneficial surgical treatment because they have poor access to specialty care,” said David I. Shalowitz, MD, a fellow in gynecologic oncology at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and first author of this study.
“While some women may benefit more from nonsurgical treatment, the results of our study showed that on average, women who received surgery lived more than 4 years, compared [with] less than 1 year for those who received only nonsurgical treatment.”
This study, published in Gynecologic Oncology, evaluated data from the National Cancer Database on patients with ovarian cancer diagnosed between 2003 and 2011. Researchers assessed data from 210,000 patients with ovarian cancer, revealing that 82% underwent surgery. Most patients (95%) who did not receive surgery had advanced stage disease.
Patients who underwent surgery lived an average of 57 months longer regardless of disease stage, compared with less than 12 months for patients who received only nonsurgical treatment. Patients who received no treatment at all lived an average of 1.4 months.
These results support previous research that shows that older women are more likely to undergo inadequate surgical treatment of cancer. Among the elderly women in this study, those who underwent surgery lived 22 months longer, compared with 10.4 months for nonsurgical treatment and 1.2 months for no treatment at all.
“Our results reinforce that patients should not be triaged away from surgical care simply because of advanced age or stage, as there seems to be a survival benefit associated with surgical treatment for these groups as well,” Shalowitz said.
“However, we were particularly concerned that nearly 23% of elderly patients with advanced stage ovarian cancer received no treatment. These untreated cases warrant further investigation as they may represent sentinel cases of failure to access or deliver appropriate cancer care.”
African American and American Indian women were approximately 35% less likely to undergo surgery than white women. In addition, uninsured and Medicaid-insured patients were approximately 50% less likely to undergo surgery than patients with private insurance.
The authors suggest that further studies to determine the nature of barriers to surgery could result in interventions that address disparities in the delivery of treatment for ovarian cancer.
1. Shalowitz DI, Epstein AJ, Ko EM, Giuntoli RL 2nd. Non-surgical management of ovarian cancer: prevalence and implications [published online May 4, 2016]. Gynecol Oncol. doi:10.1016/j.ygyno.2016.04.026.