Treatment patterns in elderly women with ovarian cancer: single center experience in the Netherlands

Introduction: Standard treatment of advanced ovarian cancer consists of cytoreductive surgery (CRS) and combination chemotherapy (CT). As elderly patients with ovarian cancer are underrepresented in trials defining standard treatment, it remains unclear which patient can endure this burdensome standard therapy and for whom therapy should be adapted. Materials and Methods: A retrospective cohort study was performed in all patients aged 70 years and older diagnosed with primary ovarian cancer between 2013 and 2014 at the Dutch Cancer Institute in Amsterdam. Patient characteristics, tumor characteristics, and treatment modalities were analyzed. Results: Eighty-two patients aged 70 years and older (median 76 years, range 70-86) were included. Patients were stratified by age into three groups: 70-74 years (G1, n=30), 75-79 years (G2, n=34), and 80+ years (G3, n=18). Patients with FIGO III-IV disease (n=72) were treated with CRS + CT (75%), CT only (15%), CRS only (4%) or no treatment (6%). The percentage of patients who started and completed standard treatment was significantly lower in the very eldery: 97% and 86% (G1), 62% and 67% (G2), and 33% and 50% (G3), respectively (p < 0.05). Median survival was not reached in group 1 and 21 months (95% CI 15-27 months) and 11 months (95% CI 7-15 months) in groups 2 and 3, respectively (p = 0.006). Conclusion: Even in this highly selected cohort of patients with advanced ovarian cancer, about one-third of patients aged 75-80 years and two-thirds of patients aged 80+ years did not start with standard treatment. The difficulty in predicting whether a patient is fit enough for the strenuous standard treatment emphasizes the need for a more objective screening tool to prevent both under- and overtreatment.

Ovarian cancer; Elderly; Treatment patterns.

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