NATIONAL SURVEY OF OVARIAN-CARCINOMA .4. PATTERNS OF CARE AND RELATEDSURVIVAL FOR OLDER PATIENTS

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.