An analysis of data for 4,617 women aged 65 years or older diagnosed with epithelial ovarian cancer found that those in the oldest age group, 80 and up, were least likely to receive any chemotherapy. While 53% of patients 80 and older received no chemotherapy, the rate was less than half (22%) for those 75 to 79, dropped down to 15.3% for those aged 70 to 74, and to 9.7% for those aged 65 to 69.
“We found that advanced age, disease stage, and comorbidities were the predominant factors in determining whether a woman initiated and completed chemotherapy,” the researchers reported in the Journal of Clinical Oncology.
While having two or more comorbidities was associated with failure to complete chemotherapy, no specific comorbidities were more common in women who did not complete chemotherapy. “Women with stage IV disease were least likely to complete their chemotherapy and most likely to be hospitalized following diagnosis,” the authors wrote.
“Among the women who received any chemotherapy, 75% had cancer-directed surgery, but only 40% who received no chemotherapy had cancer-directed surgery,” the authors noted. The women were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.
Goals and Recommendations
The stated goal of the study “was to test the hypothesis that the oldest women who received chemotherapy would use more health-care resources when compared with younger women,” but the results showed otherwise. “Among women who received either a partial or complete course of chemotherapy, we did not find an increase in use of health services (hospitalizations, emergency department visits, or physician visits) for the oldest women (age 80 years or older) compared with younger women,” the authors wrote.
The investigators suggested “increased efforts to involve elderly women in clinical trials of ovarian cancer treatment and report on their ability to complete therapy, treatment toxicity, use of health services, and quality of life.” They also called for increased efforts to improve access to chemotherapy for ovarian cancer and “to reduce disparities in treatment initiation and completion.”
Fairfield KM, et al: J Clin Oncol. Sept. 12, 2011 (early release online).
