National survey of ovarian carcinoma. IV: Patterns of care and related survival for older patients.
BACKGROUND
An analysis was conducted by the American College of Surgeons Cancer Commission evaluating the patterns of care of ovarian cancer patients diagnosed in 1983 and 1988. The purpose of this study was to investigate whether there was a difference in the care patterns of elderly ovarian cancer patients and its impact on survival.


METHODS
Data were collected from 25 consecutive patients whose disease was diagnosed 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 older. A significant reduction in survival was noted among patients 80 years and older as compared to their younger counterparts (P = 0.03-0.00001). 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%, respectively, for those less than 80 years old as compared to those greater than or equal to 80 years old. Most elderly ovarian cancer patients were cared for by nononcologists such as general surgeons (31%) and obstetricians/gynecologists (29%). As a group, older patients had fewer total abdominal hysterectomies, bilateral salpingo-oophorectomies, and omentectomies than their younger counterpart (P < 0.00001). As further evidence for a less aggressive surgical approach, the optimal tumor debulking rates of women greater than or equal to 80 years were significantly 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 chemotherapy than younger patients (42% versus 69%, P < 0.0001).


CONCLUSIONS
It appears that conservative treatments contributed to the decreased survival of older ovarian cancer patients.
Hightower
R D
RD
Division of Gynecologic Oncology, University of Miami School of Medicine, Florida.
Nguyen
H N
HN
Averette
H E
HE
Hoskins
W
W
Harrison
T
T
Steren
A
A
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000628:therapy*; D010052:Ovariectomy / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014481:United States / Q000453:epidemiology