Patterns of Care for Women With Ovarian Cancer in the United States
ABSTRACT & COMMENTARY
Synopsis: In the United States, older women with late-stage ovarian cancer do not receive recommended treatment, and the majority of women with early-stage ovarian cancer do not receive recommended staging and treatment.
Source: Muñoz KA, et al. J Clin Oncol 1997;15: 3408-3415.
Muñoz and colleagues examined the type and receipt of recommended staging and treatment of 785 women diagnosed with ovarian cancer in 1991 who were selected from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program. The purpose of this study was to characterize treatments for ovarian cancer, to determine if recommended staging and treatment were provided, and to determine factors that influence receipt of recommended staging and treatment. Muñoz et al found that most women with presumptive stage I and II ovarian cancer were treated with surgery alone (58%), while women with stage III or IV disease were treated with surgery plus platinum-based chemotherapy (stage III, 75%; stage IV, 56%). Approximately 10% of women with presumptive stage I and II, 71% with stage III, and 53% with stage IV disease received recommended staging and treatment. The absence of lymphadenectomy and assignment of histologic grade were the primary reasons women with presumptive stage I and II cancer did not receive recommended staging and treatment, whereas for stages III and IV, it was due to older women not receiving surgery plus platinum-based adjuvant chemotherapy. Age, stage, comorbidity, "other" race/ethnicity, and treatment at a facility with an approved residency training program were associated with whether recommended staging and therapy were received. Muñoz et al conclude that older women with late-stage disease did not receive recommended treatment, and the majority of women with early-stage disease did not receive recommended staging and treatment.
COMMENT BY DAVID M. GERSHENSON, MD
According to the American Cancer Society, almost 27,000 American women will have developed ovarian cancer in 1997. It is the fifth most common cancer in females and the most common cause of death from gynecologic cancer. The major findings of this study underscore the fact that a significant proportion of American women are not receiving state-of-the-art care for their ovarian cancer. For women with stage I and II disease, the main problem was lack of comprehensive surgical staging; lymphadenectomy was not performed in 66% of the women. For women with stage III or IV disease, the major problem was the lack of surgery plus platinum-based chemotherapy for older women. Muñoz et al did find that, for all stages, age at diagnosis, comorbidity score, and being of "other" race/ethnicity negatively affected the receipt of recommended treatment.
On the other hand, receiving treatment at an institution with an approved residency training program had a positive effect on receiving recommended treatment. Although this study provides some insight, the reasons for the fact that older women receive recommended treatment less frequently than younger women remain somewhat elusive. Of course, possible explanations include greater comorbidity in older women and less aggressive treatment. Clearly, further study is needed in this area. The greatest strength of this study is that the findings are derived from a national database. Further dissection of some of the issues highlighted by the study will hopefully allow us to develop better strategies to ensure optimal treatment for all women with ovarian cancer.
The major reason for the lack of recommended treatment in women with stages I and II ovarian cancer is:
a. the lack of omentectomy.
b. the lack of bilateral salpingo-oophorectomy.
c. the lack of hysterectomy.
d. the lack of lymphadenectomy.
e. the lack of peritoneal biopsies.
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