Many Women Forgo Survival-Extending Ovarian Cancer Surgery

Women with ovarian cancer could live 4 times longer after receiving surgery, but a recent study published in Gynecologic Oncology revealed that nearly 20% of women opt out.

Researchers used the National Cancer Database (NCDB) to evaluate treatment options for ovarian cancer patients from 2003 through 2011. The goal was to identify populations at risk of not receiving the standard care.

There were more than 210,000 patients assessed, with approximately 82% receiving surgical treatment. Ninety-five percent of patients who were not treated with surgery had advanced stage cancer.

The data showed that patients who had undergone surgery lived an average of 57 months, regardless of their disease stage, compared with less than 12 months for patients who only received non-surgical treatments such as radiotherapy or chemotherapy. Patients who did not receive any form of treatment lived an average of 1.4 months.

The findings were consistent with prior studies that suggested elderly women are at high risk for inadequate surgical treatment of cancer. However, the current study found that even in elderly patients who underwent surgery, survival was significantly higher at 22 months compared with patients who did not receive surgery or any treatment at all, who survived 10.4 months and 1.2 months, respectively.

“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,” said researcher David I. Shalowitz, MD. “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.”

The secondary results of the study revealed that independent of age and disease progression, American Indian and black women were about 35% less likely to receive surgery than white women. Additionally, patients who had Medicaid or were uninsured were approximately 50% less likely to undergo surgery than privately insured patients.

“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,” Shalowitz said. “While some women may benefit more from non-surgical treatment, the results of our study showed that on average, women who received surgery lived more than 4 years, compared to less than 1 year for those who received only non-surgical treatment.”

Additional research needs to be conducted to help identify barriers and hold interventions solely aimed at addressing disparities in the delivery of cancer care, the study concluded.