title: Factors associated with the suboptimal treatment of women less than 55 years of age with early-stage ovarian cancer.
abstract: OBJECTIVE
  A significant number of young patients with early-stage ovarian cancer did not receive chemotherapy based on standard practice guidelines. We investigated factors associated with the suboptimal treatment in these women.
  
  
  METHODS
  Data were obtained from California Cancer Registry from 1994 to 1996. Kaplan-Meier and Cox proportional hazard methods were used.
  
  
  RESULTS
  Of 135 younger (<55 years) patients with stages IC-II epithelial ovarian cancers, 29 (21.5%) did not receive chemotherapy (group A) while the remaining 106 (78.5%) had adjuvant chemotherapy (group B). Women in group A were more likely to live in poor neighborhoods (58.6% vs. 38.7%; p=0.055), less likely to be seen by a gynecologic oncologist (13.8% vs. 39.6%; p=0.009), and had more grade 1 and 2 tumors (58.6% vs. 37.8%; p=0.049). The 5-year disease-specific survival of group A was 70.5% compared to 76.5% in group B (p=0.252). Of note, patients residing in poor neighborhoods had a statistically significant improvement in survival (from 65.5% to 86.0%; p=0.012) associated with chemotherapy, but this difference was not noted for women in non-poor neighborhoods (77.1% vs. 70.9%; p=0.574). On multivariate analysis, those treated by gynecologic oncologists were more likely to receive chemotherapy (95% CI:1.33-12.63; p=0.006).
  
  
  CONCLUSIONS
  A significant number of young women with stages IC-II epithelial ovarian cancer did not receive chemotherapy. The factors associated with this suboptimal treatment of young women with stages IC-II ovarian cancer include living in poor neighborhoods and lack of care by a gynecologic oncologist.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Comprehensive Cancer Center, 94143-1702, USA. chanjohn@obgyn.ucsf.edu
authors.forename: John K
authors.initials: JK
authors.lastname: Chan
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kapp
authors.forename: Jacob Y
authors.initials: JY
authors.lastname: Shin
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.forename: Gary S
authors.initials: GS
authors.lastname: Leiserowitz
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.forename: Cynthia
authors.initials: C
authors.lastname: O'Malley
mesh_terms: D000328:Adult; D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D019983:Guideline Adherence; D006176:Gynecology; D006297:Health Services Accessibility; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate