Under-treatment of elderly patients with ovarian cancer: a population based study

Abstract

BackgroundOvarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age.MethodsAll patients with invasive cancer (n = 1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included. Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed. Univariate and multivariate logistic regression was used to compare treatment by age.ResultsOvarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment. This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged <70 years = 0.47 [0.24–0.91], OR for chemotherapy, age >70 vs <70 = 0.30 [0.16–0.55] and OR for surgery plus chemotherapy, age >70 vs <70 = 0.14 [0.08–0.28]). This effect of age was independent of other variables, including stage and grade. The probability of receiving standard treatment, in accordance with recommendations, was reduced by 50 % in elderly patients compared to their younger counterparts. Overall and net survival of elderly patients with standard treatment was similar to those of younger patients treated outside standard treatment.ConclusionsElderly women with ovarian cancer were therapeutically disadvantaged compared to younger women. Further studies including co morbidities are necessary to refine these results and to improve therapeutic management of elderly patients with ovarian cancer.

Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

“…5 A French population-based study showed that the probability of undergoing guidelines recommended treatment was 2 times lower in women aged 70 years or older compared with the younger counterparts. 7 In the present series, OS was significantly worse in women aged older than 75 years than in the younger counterparts (median, 98 vs 30 months, P = 0.016). The PS, tumor stage, and comorbidities were similar in the 2 age groups, and 24.8% received chemotherapy only, 41.8% underwent PDS and chemotherapy in an optimal timeframe, and 15.1% had PDS and chemotherapy, but the timing was not optimal or patients did not complete all 6 cycles of chemotherapy.…”

Safety and Efficacy of Extended Bevacizumab Therapy in Elderly (≥70 Years) Versus Younger Patients Treated for Newly Diagnosed Ovarian Cancer in the International ROSiA Study

“…For example, in a French registry study, 41% of all patients diagnosed with ovarian cancer in the Hérault region between 2008 and 2011 were aged 70 years or older. 24 Additional limitations of the present analysis include the absence of a control arm and the lack of information on geriatric assessment domains, such as functional status, psychological state, cognitive function, nutritional status, and social support, which may help in identifying which elderly patients are most likely to benefit or not from treatment. 8 Despite such drawbacks, these exploratory analyses provide much-needed information on the tolerability of bevacizumab-containing therapy in older patients with newly diagnosed ovarian cancer and support the use of this regimen in older as well as younger patients for whom this treatment option is available.…”

Cardio-oncology in the older adult

“…Older patients are frequently offered lower doses of chemotherapy due to concerns of toxicity, presumed frailty, and the high likelihood of coexisting comorbidities. Several observational studies have noted poorer outcomes in this group possibly due to undertreatment and age-related factors (8, 9). As a result, optimal care of older adults with cancer necessitates evidence-based and guideline-directed care specific to this vulnerable group.…”

“…Cancer-specific mortality is often higher in older patients, likely due to the impact of age-related factors (35, 56). Evidence from observational studies suggests possible undertreatment, as elderly patients are frequently offered lower doses of chemotherapy due to concern for cardiotoxicity (8, 57). Additionally, alternative treatments exist in some instances, data continue to show significantly better cancer-specific outcomes with first-line treatments such as anthracyclines and trastuzumab in some patient populations (9, 58–61).…”