Factors associated with the suboptimal treatment of women less than 55 years of age with early-stage ovarian cancer

ObjectivesA significant number of young patients with early-stage ovarian cancer did not receive chemotherapy based on standard practice guidelines. We investigated factors associated with the suboptimal treatment in these women.Materials and MethodsData were obtained from California Cancer Registry from 1994 to 1996. Kaplan–Meier and Cox proportional hazard methods were used.ResultsOf 135 younger (< 55 years) patients with stages IC–II epithelial ovarian cancers, 29 (21.5%) did not receive chemotherapy (group A) while the remaining 106 (78.5%) had adjuvant chemotherapy (group B). Women in group A were more likely to live in poor neighborhoods (58.6% vs. 38.7%; p = 0.055), less likely to be seen by a gynecologic oncologist (13.8% vs. 39.6%; p = 0.009), and had more grade 1 and 2 tumors (58.6% vs. 37.8%; p = 0.049). The 5-year disease-specific survival of group A was 70.5% compared to 76.5% in group B (p = 0.252). Of note, patients residing in poor neighborhoods had a statistically significant improvement in survival (from 65.5% to 86.0%; p = 0.012) associated with chemotherapy, but this difference was not noted for women in non-poor neighborhoods (77.1% vs. 70.9%; p = 0.574). On multivariate analysis, those treated by gynecologic oncologists were more likely to receive chemotherapy (95% CI:1.33–12.63; p = 0.006).DiscussionA significant number of young women with stages IC–II epithelial ovarian cancer did not receive chemotherapy. The factors associated with this suboptimal treatment of young women with stages IC–II ovarian cancer include living in poor neighborhoods and lack of care by a gynecologic oncologist.