title: Ovarian cancer outcomes: Predictors of early death.
abstract: OBJECTIVE
  To describe the outcomes and mortality in advanced ovarian cancer patients in a population-based cohort in the 90 days after diagnosis.
  
  
  METHODS
  Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified a cohort of women with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. A χ(2) test was used to assess demographic and clinical factors. Kaplan-Meier curves and Cox proportional hazards models were used to assess factors associated with variation in survival.
  
  
  RESULTS
  Of the 9491 patients with stage III/IV ovarian cancer identified from the SEER/Medicare system, 4131 (43.6%) patients died in the first year after diagnosis. Of these, 2472 (26.0%) patients died in the first 90 days after diagnosis. Over the study period, the number of patients who died in the first 90 days after diagnosis slightly increased (p=0.053). Older age (>75 years of age), increased comorbidity, stage IV disease, lack of a visit with a gynecologic oncologist, and surgery were associated with an increase in 90-day mortality. Chemotherapy was associated with a reduction in 90-day mortality.
  
  
  CONCLUSIONS
  Approximately 25% of patients with advanced ovarian cancer in our study period died within 90 days of diagnosis, and more than 40% died within the first year of diagnosis. In addition, a substantial proportion of patients did not receive any treatment. Further research into the characteristics of these patients should be performed to elucidate clinical areas for intervention to either prevent these poor outcomes or allocate appropriate resources to patients with extremely poor prognoses.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States. Electronic address: urbanr@u.washington.edu.
authors.forename: Renata R
authors.initials: RR
authors.lastname: Urban
authors.affiliation: Surgical Outcomes Research Center, University of Washington, Seattle, WA, United States.
authors.forename: Hao
authors.initials: H
authors.lastname: He
authors.affiliation: Surgical Outcomes Research Center, University of Washington, Seattle, WA, United States.
authors.forename: Raphael
authors.initials: R
authors.lastname: Alfonso
authors.affiliation: Alaska Women's Cancer Care, Anchorage, AK, United States.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hardesty
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Gray
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D061213:Mortality, Premature; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Chemotherapy; Education; Ovarian cancer; Resource allocation; Surgery