abstract
OBJECTIVE:
To evaluate whether overall survival is improving among women in the United States with advanced ovarian cancer.
METHODS:
This
retrospective cohort study evaluated trends in treatment and overall
survival for women older than 65 years diagnosed with stage III and IV
epithelial ovarian cancer between 1995 and 2008 using Surveillance,
Epidemiology, and End Results-Medicare data. Parametric and
semiparametric multivariate survival analyses were used to assess
comparative treatment survival rates and factors affecting survival and
recurrence.
RESULTS:
Of
7,938 women who met study criteria, 2.9% received no treatment, 15.4%
underwent surgery only, 24.8% received chemotherapy only, 41.8%
underwent primary debulking surgery and chemotherapy in an optimal
timeframe, and 15.1% had primary debulking surgery and chemotherapy, but
the timing was not optimal or patients did not complete all six cycles
of chemotherapy. Those who underwent surgery only had similar survival
as those who received no treatment (2.2 compared with 1.7 months),
whereas those who received chemotherapy only had a better overall
survival (14.4 months). Optimal treatment was associated with the
longest survival time (P<.001, median overall survival 39.0 months).
Additionally, survival time associated with optimal treatment increased
over the past decade. However, the proportion of women who received
optimal treatment has decreased over the past decade.
CONCLUSION:
Elderly
women with advanced ovarian cancer have the best survival with optimal
therapy. When this is not offered or possible, chemotherapy alone offers
better survival than surgery alone.
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