Rd. Hightower et al., NATIONAL SURVEY OF OVARIAN-CARCINOMA .4. PATTERNS OF CARE AND RELATEDSURVIVAL FOR OLDER PATIENTS, Cancer, 73(2), 1994, pp. 377-383
Background. An analysis was conducted by the American College of Surge
ons Cancer Commission evaluating the patterns of care of ovarian cance
r patients diagnosed in 1983 and 1988. The purpose of this study was t
o investigate whether there was a difference in the care patterns of e
lderly ovarian cancer patients and its impact on survival. Methods. Da
ta were collected from 25 consecutive patients whose disease was diagn
osed initially at 904 participating hospitals with cancer programs in
1983 and 1988. The survival and care of patients greater than or equal
to 80 years of age were compared to those less than 80 years of age.
Results. Of the 12,316 patients evaluated, 1,115 were 80 years or olde
r. A significant reduction in survival was noted among patients 80 yea
rs and older as compared to their younger counterparts (P = 0.03-0.000
01). The 5-year survivals were: stage I, 89% versus 79%; stage II, 58%
versus 40%; stage III, 25% versus 11%; and stage IV, 13% versus 3%, r
espectively, for those less than 80 years old as compared to those gre
ater than or equal to 80 years old. Most elderly ovarian cancer patien
ts were cared for by nononcologists such as general surgeons (31%) and
obstetricians/gynecologists (29%). As a group, older patients had few
er total abdominal hysterectomies, bilateral salpingo-oophorectomies,
and omentectomies than their younger counterpart (P < 0.00001). As fur
ther evidence for a less aggressive surgical approach, the optimal tum
or debulking rates of women greater than or equal to 80 years were sig
nificantly less than those of younger patients (P < 0.001). There was
no significant increase in anesthesia complications between age groups
. Generally, older patients are less likely to receive adjuvant chemot
herapy than younger patients (42% versus 69%, P < 0.0001). Conclusion.
It appears that conservative treatments contributed to the decreased
survival of older ovarian cancer patients.