Study: Older Women Received Less Treatment for Ovarian Cancer

Women older than 70 received less treatment for ovarian cancer than did their younger counterparts, according to the results of a single-center French study. In fact, these women received less treatment regardless of stage or grade of their disease.

“The cancer characteristics being equal, elderly women had less chance of receiving standard therapy, ie, the recommended treatment by current guidelines,” Elisabeth Fourcadier, of Cancer Registry of Hérault Departement of France, ICM, and colleagues wrote in BMC Cancer. “Elderly patients in whom guidelines-recommended treatment was not applied had poorer likelihood of survival as compared to elderly patients who received guidelines-recommended therapy, and as compared to younger women.”

According to the study, older women are more likely to have a delayed diagnosis of ovarian cancer and are more likely to be diagnosed at an advanced stage. Surgery with or without chemotherapy is the standard treatment for ovarian cancer and previous studies have shown that this aggressive treatment may be less likely to be used in older populations.

In this study, Fourcadier and colleagues looked at 1,151 women diagnosed with invasive ovarian cancer between 1997 and 2011; about 40% of women were aged 70 or older. They analyzed their age, cancer characteristics, and treatment.

Older women were more likely to be diagnosed at a more advanced stage compared with younger women (P < .0001). In addition, older women were less likely to undergo or have unknown histology testing results (P < .001).

Overall, their analysis revealed that older women with ovarian cancer received less treatment compared with younger women regardless of the treatment type. Whereas 60.9% of older women underwent surgery, 89.6% of younger women did (P < .001). Similarly, only 57.4% of older women underwent chemotherapy compared with 76.4% of younger women (P < .001). Multivariate adjustments showed that older women were 3.6 times less likely to have surgery and three times less likely to be assigned chemotherapy compared with younger women. Similar disparities were discovered according to cancer stage.

The researchers conducted a multivariate regression adjusted analysis for cancer characteristics, treatment location, and period of diagnosis and found a gradient effect between treatment and age linked to the introduction of chemotherapy and its association with surgery:

• Odds ratio (OR) for surgery in women > 70 vs ≤ 70 years, 0.46;

• OR for chemotherapy > 70 vs ≤ 70 years, 0.29; and

• OR for surgery plus chemotherapy > 70 vs ≤ 70 years, 0.13.

“Furthermore, we showed that standard guidelines-recommended therapy was less frequently applied in the elderly, and hence, elderly patients were 50% less like to receive standard therapy than younger patients,” the researchers wrote. “Elderly patients have improved likelihood of survival when recommended treatment is applied. Further research, however, is warranted to investigate whether the independent effect of age persists in the presence of comorbidity.”