Non-surgical management of ovarian cancer: Prevalence and implications.
To identify prevalence, correlates and survival implications of non-surgically managed epithelial ovarian cancer (EOC).



The National Cancer Database (NCDB) was queried for EOC cases between 2003 and 2011. Type of treatment, survival data, reasons for non-surgical treatment, clinicopathologic and process-based factors were collected. Logistic regression identified independent predictors of surgical treatment; Cox proportional hazards regression modeled association between time to death and receipt of surgery.



172,687 of 210,667 patients (82%) received surgical treatment for EOC. 95% of patients treated non-surgically had stage III, stage IV or unknown stage disease. The reason for non-surgical treatment was unclear in 80% of cases. Black race and uninsurance were significantly associated with non-surgical treatment. Median survival time was 57.4months (95% CI: 56.8-57.9) for surgery with or without systemic treatment compared to 11.9months (95% CI: 11.6-12.2) for systemic treatment alone and 1.4months (95% CI: 1.3-1.4) for no treatment. Relative to surgical treatment, the adjusted hazard ratio for death associated with systemic treatment alone was 1.9 (p<0.001); hazard ratio for untreated patients was 4.7 (p<0.001). Among 29,921 patients older than 75 with Stage III/IV disease, 21.5% received only systemic treatment; 22.8% were entirely untreated.



18% of EOC patients in the NCDB did not receive surgical treatment. These patients experienced significantly worsened survival. Prospective investigation is needed to determine how often apparent deviation from best-practices guidelines is clinically appropriate. Non-surgically treated patients may be at risk for poor access to gynecologic oncology care and deserve further study.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: david.shalowitz@uphs.upenn.edu.
David I
DI
Shalowitz
Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Andrew J
AJ
Epstein
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States.
Emily M
EM
Ko
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States.
Robert L
RL
Giuntoli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
Cancer care delivery research; Health disparities; Health policy; Health services research; Ovarian cancer