Trends in the receipt of guideline care and survival for women with ovarian cancer: A population-based study

• Published in: Gynecologic oncology Vol. 145; no. 3; pp. 486 - 492
• Main Authors: Warren, Joan L, Harlan, Linda C, Trimble, Edward L, Stevens, Jennifer, Grimes, Melvin, Cronin, Kathleen A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Carcinoma, Ovarian Epithelial; Chemotherapy, Adjuvant - standards; Chemotherapy, Adjuvant - statistics & numerical data; Cohort Studies; Female; Guideline Adherence - statistics & numerical data; Guideline care; Gynecologic Surgical Procedures - methods; Gynecologic Surgical Procedures - standards; Gynecologic Surgical Procedures - statistics & numerical data; Hematology, Oncology and Palliative Medicine; Humans; Logistic Models; Middle Aged; Neoplasms, Glandular and Epithelial - drug therapy; Neoplasms, Glandular and Epithelial - mortality; Neoplasms, Glandular and Epithelial - surgery; Neoplasms, Glandular and Epithelial - therapy; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - mortality; Ovarian Neoplasms - surgery; Ovarian Neoplasms - therapy; Retrospective Studies; SEER Program; Survival; Treatment; Trends; United States - epidemiology; United States; Guideline care; Treatment; Trends; Survival; Ovarian cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2017.03.016

Abstract Background We assessed trends in the receipt of guideline care and 2-year cause-specific survival for women diagnosed with ovarian cancer. Methods This retrospective cohort analysis used National Cancer Institute's Patterns of Care studies data for women diagnosed with ovarian cancer in 2002 and 2011 (weighted n = 6427). Data included patient characteristics, treatment type, and provider characteristics. We used logistic regression to evaluate the association of year of diagnosis with receipt of guideline surgery, multiagent chemotherapy, or both. Two-year cause-specific survival, 2002–2013, was assessed using SEER data. Results The adjusted rate of women who received stage-appropriate surgery, 48%, was unchanged from 2002 to 2011. Gynecologic oncologist (GO) consultations increased from 43% (2002) to 78% (2011). GO consultation was a significant predictor for receipt of guideline care, although only 40% of women who saw a GO received guideline surgery and chemotherapy. The percent of women who received guideline surgery and chemotherapy increased significantly from 32% in 2002 to 37% in 2011. From 2002 to 2011, 2-year cause-specific ovarian cancer survival was unchanged for Stages I-III cancers, with slight improvement for Stage IV cancers. Conclusion Receipt of guideline care has improved modestly from 2002–2011 for women with ovarian cancer. Current treatment is far below clinical recommendations and may explain limited improvement in 2-year cause-specific survival. Most women consulted a GO in 2011 yet did not receive guideline care. There needs to be a better understanding of the decision-making process about treatment during the consultation with GOs and other factors precluding receipt of guideline care.