Non-surgical management ovarian cancer: Prevalence/implications (no treatment=1.4 month survival)

abstract
  July 2016

Highlights

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18% of EOC patients in the NCDB did not receive surgical treatment.

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22% of elderly patients with advanced disease received only systemic treatment; 23% were untreated.

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It is unclear how often deviation from best-practices guidelines is clinically appropriate.

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Purpose

To identify prevalence, correlates and survival implications of non-surgically managed epithelial ovarian cancer (EOC).

Methods

The National Cancer Database (NCDB) was queried for EOC cases between 2003 and 2011. Type of treatment, survival data, reasons for non-surgical treatment, clinicopathologic and process-based factors were collected. Logistic regression identified independent predictors of surgical treatment; Cox proportional hazards regression modeled association between time to death and receipt of surgery.

Results

172,687 of 210,667 patients (82%) received surgical treatment for EOC. 95% of patients treated non-surgically had stage III, stage IV or unknown stage disease. The reason for non-surgical treatment was unclear in 80% of cases. Black race and uninsurance were significantly associated with non-surgical treatment. Median survival time was 57.4 months for surgery with or without systemic treatment compared to 11.9 months for systemic treatment alone and 1.4 months for no treatment. Relative to surgical treatment, the adjusted hazard ratio for death associated with systemic treatment alone was 1.9.  Among 29,921 patients older than 75 with Stage III/IV disease, 21.5% received only systemic treatment; 22.8% were entirely untreated.

Conclusion

18% of EOC patients in the NCDB did not receive surgical treatment. These patients experienced significantly worsened survival. Prospective investigation is needed to determine how often apparent deviation from best-practices guidelines is clinically appropriate. Non-surgically treated patients may be at risk for poor access to gynecologic oncology care and deserve further study.

Keywords

• Health disparities;
• Health services research;
• Ovarian cancer;
• Health policy;
• Cancer care delivery research