title: Ovarian Cancer Treatment and Survival Trends Among Women Older Than 65 Years of Age in the United States, 1995-2008.
abstract: OBJECTIVE
  To evaluate whether overall survival is improving among women in the United States with advanced ovarian cancer.
  
  
  METHODS
  This retrospective cohort study evaluated trends in treatment and overall survival for women older than 65 years diagnosed with stage III and IV epithelial ovarian cancer between 1995 and 2008 using Surveillance, Epidemiology, and End Results-Medicare data. Parametric and semiparametric multivariate survival analyses were used to assess comparative treatment survival rates and factors affecting survival and recurrence.
  
  
  RESULTS
  Of 7,938 women who met study criteria, 2.9% received no treatment, 15.4% underwent surgery only, 24.8% received chemotherapy only, 41.8% underwent primary debulking surgery and chemotherapy in an optimal timeframe, and 15.1% had primary debulking surgery and chemotherapy, but the timing was not optimal or patients did not complete all six cycles of chemotherapy. Those who underwent surgery only had similar survival as those who received no treatment (2.2 compared with 1.7 months), whereas those who received chemotherapy only had a better overall survival (14.4 months). Optimal treatment was associated with the longest survival time (P<.001, median overall survival 39.0 months). Additionally, survival time associated with optimal treatment increased over the past decade. However, the proportion of women who received optimal treatment has decreased over the past decade.
  
  
  CONCLUSIONS
  Elderly women with advanced ovarian cancer have the best survival with optimal therapy. When this is not offered or possible, chemotherapy alone offers better survival than surgery alone.
authors.affiliation: Division of General Internal Medicine, the Department of Population Health Science and Policy, and the Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Lin
authors.forename: Natalia
authors.initials: N
authors.lastname: Egorova
authors.forename: Rebeca
authors.initials: R
authors.lastname: Franco
authors.forename: Monica
authors.initials: M
authors.lastname: Prasad-Hayes
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents