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One in 5 women with ovarian cancer does not undergo surgery, Penn study reveals

Nearly 20 percent of women with ovarian cancer do not undergo surgery, despite it being a standard part of treatment recommendations, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings, which suggest women may live four times longer with surgical treatment, were especially striking among older patients; researchers found that nearly half of women over 75 with stage III/IV cancer do not have surgery and roughly 25 percent receive no treatment at all. The study is published this month in the journal Gynecologic Oncology.

“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. “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 four years, compared to less than one year for those who received only non-surgical treatment.”

Researchers used the National Cancer Database (NCDB) – a database that captures roughly 70 percent of new cancer cases in the United States annually – to evaluate treatment plans for patients with ovarian cancer from 2003 through 2011, in order to identify populations at risk of not receiving the standard of care for their disease. More than 210,000 patients were assessed with approximately 82 percent (172,600) receiving surgical treatment. The vast majority (95 percent) of patients treated without surgery had advanced stage cancer.

Regardless of disease stage, patients who received surgery lived an average of 57 months, compared to less than 12 months for patients who received only non-surgical treatment (such as chemotherapy or radiation therapy), and 1.4 months for patients who received no treatment at all.

Study findings were consistent with previous research suggesting that elderly women are at high-risk for inadequate surgical treatment of cancer. However, even for elderly patients, those who received surgical treatment had significantly higher survival (22 months) compared to those who received only non-surgical treatment or no treatment at all (10.4 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,” Shalowitz said. “However, we were particularly concerned that nearly 23 percent 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.”

Secondary results of the study showed that independent of age and disease stage, black and American Indian women were approximately 35 percent less likely to undergo surgery than white women, and uninsured and Medicaid-insured patients were roughly 50 percent less likely to undergo surgery than privately insured patients. Though there may be many reasons why patients would not receive surgical interventions – including extensive disease or other significant health problems – the authors say further study of these cases could help identify barriers and lead to interventions specifically aimed at addressing disparities in cancer care delivery.

Article: Non-surgical management of ovarian cancer: Prevalence and implications, David I. Shalowitz, Andrew J. Epstein, Emily M. Ko, Robert L. Giuntoli II, Gynecologic Oncology, doi:10.1016/j.ygyno.2016.04.026, published online 5 May 2016.