The Impact of Age on the Treatment and Survival of Ovarian Cancer Patients

Purpose: Although a significant number of patients diagnosed with ovarian cancer are over the age of 65, these patients are less likely to receive standard therapy and are underrepresented in clinical studies. The objective of our study was to evaluate the treatment and survival of patients over the age of 65 years. Patients and Methods: All patients diagnosed with epithelial ovarian carcinoma who underwent primary surgical cytoreduction followed by taxane/platinum–based combination chemotherapy between 1996-2005 were eligible. Patient demographics, surgical outcomes, treatment outcomes, and survival were calculated. Kaplan-Meier survival analyses, χ2 test, Fisher exact test, and multivariate analysis were used for statistical analysis. Results: A total of 330 patients were identified between 1996-2005: 199 patients ≤ age 65 years and 131 patients > age 65 years. The groups were similar in regard to race, stage, and histology. Patients > age 65 years were less likely to be obese (body mass index ≥ 30; 16% vs. 28%; P = .02). Surgical outcomes were similar between the groups including debulking status, grade, estimated blood loss, intraoperative complications, postoperative complications, and length of hospital stay. Chemotherapy outcomes were also similar in regard to courses of chemotherapy, number of platinum-based therapies, number of total cycles, and incidence of neutropenia. Elderly patients were significantly less likely to be on a clinical trial (25% vs. 37%; P = .01) and more likely to recur (82% vs. 72%; P = .04). Elderly patients had a worse median progression-free survival (9 months vs. 15 months; P = .05) and overall survival (38 months vs. 47 months; P = .002). Elderly patients on clinical trials demonstrated an overall survival advantage compared with those not on a clinical trial (41 months vs. 32 months; P = .03). Conclusion: Although elderly patients with ovarian cancer experienced similar surgical and chemotherapeutic outcomes compared with younger patients, survival was worse in elderly patients. Elderly patients are still underrepresented on clinical trials despite favorable survival outcomes. More research is needed in order to optimize the treatment of this cohort.