Ovarian carcinoma: Care and survival in a community-based population

Background: Previous studies of the management and costs of ovarian cancer have been based on data from oncology practices. Such studies may exclude p atients who are not candidates for treatment and may not account for costs incurred during diagnosis or primary treatment. Objective: The purpose of this study was to describe the epidemiology, mana gement, and costs of care of ovarian cancer in a geographically defined pop ulation to better rt fleet the total spectrum of the disease and its: care. Methods: We conducted a retrospective review of the medical records of all residents of Olmsted County, Minnesota, who received a first diagnosis of e pithelial ovarian carcinoma (including postmortem diagnoses) between 1985 a nd 1997, Results: Of the 107 women with a new diagnosis of ovarian carcinoma, 42 (39 %) had stage I or II tumors at the time of diagnosis. The mean age of the p atients at the time of diagnosis was 64.7 years, and 20% were nulliparous. The diagnostic assessment for ovarian carcinoma was initiated by a family p hysician or internist in 50% of cases and by an obstetrician or gynecologis t in 16% of cases. One hundred two patients (95%) underwent surgical treatm ent, and 80 (75%) received primary chemotherapy. The 5-year survival rate w as 88% in those with stage I or II tumors and 17% in those with stage III o r IV tumors. The mean charges for secondary care were higher than those for primary care ($36,110 vs $32,367; P < 0.05) in those receiving both types of therapy. Fifty percent of those dying of ovarian cancer received hospice care for a mean of 39.0 days before death. Conclusions: Most assessments leading to a diagnosis of ovarian carcinoma w ere initiated by primary carl physicians. In this community-based populatio n, early-stage and low-grade turners were common (<greater than or equal to >30%) and were associated with lower costs of care and higher 5-year surviv al rates. Total treatment costs for those requiring secondary therapy were approximately twice the costs for those requiring primary treatment only, w ith similar to 50% of costs associated with inpatient care.