Why women do not have surgical treatment for advanced stage ovarian cancer: cohort study from east London cancer centre

ABSTRACT

ObjectivesThe Ovarian Cancer Audit Feasibility Pilot found that nearly 40% of patients diagnosed with ovarian cancer in the United Kingdom did not have surgical treatment with a large degree of geographical variation, highlighting the need to look at these discrepancies within each cancer centre. This audit set out to identify women within Barts Health NHS Foundation Trust with stage 3 or 4 ovarian cancer who did not have surgical management, determine their demographics and the reasons for not having surgery.MethodsData was collected retrospectively from MDT proformas over a 5-year period (2016–2021) and analysed using Microsoft Excel and SPSS software.Results92 women who were diagnosed with stage 3/4 ovarian cancer did not have surgical treatment. 59.7% (55/92) had chemotherapy. The mean age was 76.2 years (55–100, n=92) and the mean Charlson Comorbidity Index was 9.9 (6–14, n=92). The majority of women had stage 4 disease (58.7%, 55/92) and high-grade serous pathology (83.7%, 77/92). The most common reason for not having surgery was unresectable disease (63%, 58/92) followed by ‘poor performance status’ (40.2%, 37/92) as detailed in MDT recommendations. Of those who did not have chemotherapy, the most common reason was poor performance status (59.3%, 16/27). 6.5% (6/92) had their treatment impacted by the COVID-19 pandemic.ConclusionsAlthough this reflects the correlation between poor performance status and likelihood of treatment, unresectability of disease may reflect geographical variation in timely diagnosis. Further work is needed to determine the impact of these factors on local 5-year survival rates.