One in 5 women with ovarian cancer does not undergo surgery, Penn study reveals
PHILADELPHIA, PA — Nearly 20 percent of women with ovarian cancer do not undergo surgery, despite it being a standard part of treatment recommendations, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings, which suggest women may live four times longer with surgical treatment, were especially striking among older patients; researchers found that nearly half of women over 75 with stage III/IV cancer do not have surgery and roughly 25 percent receive no treatment at all. The study is published this month in the journal Gynecologic Oncology.
"Though surgery isn't right for every patient, we suspect that some women do not receive beneficial surgical treatment because they have poor access to specialty care," said David I. Shalowitz, MD, a fellow in Gynecologic Oncology at the Perelman School of Medicine at the University of Pennsylvania. "While some women may benefit more from non-surgical treatment, the results of our study showed that on average, women who received surgery lived more than four years, compared to less than one year for those who received only non-surgical treatment."
Researchers used the National Cancer Database (NCDB) – a database that captures roughly 70 percent of new cancer cases in the United States annually – to evaluate treatment plans for patients with ovarian cancer from 2003 through 2011, in order to identify populations at risk of not receiving the standard of care for their disease. More than 210,000 patients were assessed with approximately 82 percent (172,600) receiving surgical treatment. The vast majority (95 percent) of patients treated without surgery had advanced stage cancer.
Regardless of disease stage, patients who received surgery lived an average of 57 months, compared to less than 12 months for patients who received only non-surgical treatment (such as chemotherapy or radiation therapy), and 1.4 months for patients who received no treatment at all.
Study findings were consistent with previous research suggesting that elderly women are at high-risk for inadequate surgical treatment of cancer. However, even for elderly patients, those who received surgical treatment had significantly higher survival (22 months) compared to those who received only non-surgical treatment or no treatment at all (10.4 and 1.2 months, respectively).
"Our results reinforce that patients should not be triaged away from surgical care simply because of advanced age or stage, as there seems to be a survival benefit associated with surgical treatment for these groups as well," Shalowitz said. "However, we were particularly concerned that nearly 23 percent of elderly patients with advanced-stage ovarian cancer received no treatment. These untreated cases warrant further investigation as they may represent sentinel cases of failure to access or deliver appropriate cancer care."
Secondary results of the study showed that independent of age and disease stage, black and American Indian women were approximately 35 percent less likely to undergo surgery than white women, and uninsured and Medicaid-insured patients were roughly 50 percent less likely to undergo surgery than privately insured patients. Though there may be many reasons why patients would not receive surgical interventions – including extensive disease or other significant health problems – the authors say further study of these cases could help identify barriers and lead to interventions specifically aimed at addressing disparities in cancer care delivery.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.