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Schuurman MS, Veldmate G, Ebisch RMF, de Hullu JA, Lemmens VEPP, van der Aa MA. Vulvar squamous cell carcinoma in women 80 years and older: Treatment, survival and impact of comorbidities. Gynecol Oncol 2023; 179:91-96. [PMID: 37951042 DOI: 10.1016/j.ygyno.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Despite being a disease of mainly older women, little is known about the clinical management of older women with vulvar squamous cell carcinoma (VSCC). We evaluated their daily clinical management compared with younger women, and established the prevalence of comorbidities and its impact on overall survival (OS). METHODS All Dutch women diagnosed with VSCC from 2015 to 2020 (n = 2249) were selected from the Netherlands Cancer Registry. Women aged ≥80 years (n = 632, 28%) were defined as "older" patients, women <80 years were considered as "younger". Chi-square tests were performed to evaluate differences in treatment by age group and comorbidities. Differences in OS were evaluated using Kaplan-Meier Curves and log-rank test. RESULTS The vast majority of both older (91%) and younger (99%) patients with FIGO IA VSCC received surgical treatment of the vulva. Older FIGO IB-IV VSCC patients were less likely to undergo groin surgery than younger patients (50% vs. 84%, p < 0.01). Performance of surgical treatment of the vulva and groin(s) was not associated with the number of comorbidities in older patients (p = 0.67 and p = 0.69). Older patients with ≥2 comorbidities did have poorer OS compared to women with one or no comorbidities (p < 0.01). CONCLUSION The vast majority of older patients underwent vulvar/local surgery. Older patients less often received groin surgery compared to younger patients. The majority of older patients had at least one comorbidity, but this did not impact treatment choice. The poorer survival in older VSCC patients may therefore be due to death of competing risks instead of VSCC itself.
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Affiliation(s)
- Melinda S Schuurman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Guus Veldmate
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renée M F Ebisch
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maaike A van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Ekmann-Gade AW, Høgdall C, Seibæk L, Noer MC, Rasmussen A, Schnack TH. Days alive and out of hospital after surgical treatment of epithelial ovarian cancer: A Danish nationwide cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107039. [PMID: 37639861 DOI: 10.1016/j.ejso.2023.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Days alive and out of hospital (DAOH) is a validated outcome measure in perioperative trials integrating information on primary hospitalization, readmissions, and mortality. It is negatively associated with advanced age. However, DAOH has not been described for surgical treatment of epithelial ovarian cancer (EOC), primarily diagnosed in older patients. METHODS We conducted a Danish nationwide cohort study including patients undergoing debulking surgery for EOC from 2013 to 2018. DAOH was explored for 30 (DAOH30), 90 (DAOH90), and 180 (DAOH180) postoperative days in younger (<70 years) and older (≥70 years) patients with advanced-stage disease stratified by surgical modality (primary (PDS) or interval debulking surgery (IDS)). We examined the associations between patient- and surgical outcomes and low or high DAOH30. RESULTS Overall, 1168 patients had stage IIIC-IV disease and underwent debulking surgery. DAOH30 was 22 days [interquartile range (IQR): 18, 25] and 23 days [IQR: 18, 25] for younger and older patients treated with PDS, respectively. For IDS, DAOH30 was 25 days [IQR: 22, 26] for younger and 25 days[IQR: 21, 26] for older patients. We found no significant differences between age cohorts regarding DAOH30, DAOH90, and DAOH180. Low DAOH30 was associated with poor performance status, PDS, extensive surgery, and long duration of surgery in adjusted analysis. CONCLUSIONS DAOH did not differ significantly between age cohorts. Surgical rather than patient-related factors were associated with low DAOH30. Our results likely reflect a high selection of fit older patients for surgery, reducing the patient-related differences between younger and older patients receiving surgical treatment.
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Affiliation(s)
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Seibæk
- Department of Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Calundann Noer
- Department of Gynecology and Obstetrics, Herlev University Hospital, Herlev, Denmark
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British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel) 2023; 15:cancers15020337. [PMID: 36672287 PMCID: PMC9856668 DOI: 10.3390/cancers15020337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.
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Impact of surgery and chemotherapy timing on outcomes in older versus younger epithelial ovarian cancer patients: A nationwide Danish cohort study. J Geriatr Oncol 2023; 14:101359. [PMID: 35989185 DOI: 10.1016/j.jgo.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To explore differences in surgical complexity, chemotherapy administration, and treatment delays between younger and older Danish patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS We included a nationwide cohort diagnosed with EOC from 2013 to 2018. We described surgical complexity and outcomes, the extent of chemotherapy and treatment delays stratified by age (<70 and ≥ 70 years), and surgical modality (primary, interval, or no debulking surgery). RESULTS In total, we included 2946 patients. For patients with advanced-stage disease, 52% of the older patients versus 25% of the younger patients did not undergo primary debulking surgery (PDS) or interval debulking surgery (IDS). For patients undergoing PDS or IDS, older patients underwent less extensive surgery and more often had residual disease after surgery >0 cm compared to younger patients. Furthermore, older patients were less often treated with chemotherapy. Older patients had PDS later than younger. We did not find any differences between age groups concerning treatment delays. Two-year cancer-specific survival differed significantly between age groups regardless of curatively intended treatment. DISCUSSION This study demonstrates that older patients are treated less actively concerning surgical and oncological treatment than younger patients, leading to worse cancer-specific survival. Older patients do not experience more treatment delays than younger ones.
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Hiu S, Bryant A, Gajjar K, Kunonga PT, Naik R. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2022; 8:CD007697. [PMID: 36041232 PMCID: PMC9427128 DOI: 10.1002/14651858.cd007697.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced-stage epithelial ovarian cancer. SEARCH METHODS We searched CENTRAL (2021, Issue 11), MEDLINE Ovid and Embase Ovid up to November 2021. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) or non-randomised studies (NRS), analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in women with advanced primary epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. We identified three NRS and conducted meta-analyses where possible. MAIN RESULTS We identified three retrospective observational studies for inclusion in the review. Two studies included women exclusively undergoing upfront primary debulking surgery (PDS) and the other study including both PDS and interval debulking surgical (IDS) procedures. All studies were at critical risk of bias due to retrospective and non-randomised study designs. Meta-analysis of two studies, assessing 397 participants, found that women who underwent radical procedures, as part of PDS, may have a lower risk of mortality compared to women who underwent standard surgery (adjusted HR 0.60, 95% CI 0.43 to 0.82; I2 = 0%; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis including women with more-extensive disease (carcinomatosis) (adjusted HR 0.61, 95% CI 0.44 to 0.85; I2 = 0%; n = 283, very low-certainty evidence), but the evidence is very uncertain. One study reported a comparison of radical versus standard surgical procedures associated with both PDS and IDS procedures, but a multivariate analysis was only undertaken for disease-free survival (DFS) and therefore the certainty of the evidence was not assessable for overall survival (OS) and remains very low. The lack of reporting of OS meant the study was at high risk of bias for selective reporting of outcomes. One study, 203 participants, found that women who underwent radical procedures as part of PDS may have a lower risk of disease progression or death compared to women who underwent standard surgery (adjusted HR 0.62, 95% CI 0.42 to 0.92; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis in one study including women with carcinomatosis (adjusted HR 0.52, 95% CI 0.33 to 0.82; n = 139; very low-certainty evidence), but the evidence is very uncertain. A combined analysis in one study found that women who underwent radical procedures (using both PDS and IDS) may have an increased chance of disease progression or death than those who received standard surgery (adjusted HR 1.60, 95% CI 1.11 to 2.31; I2 = 0%; n = 527; very low-certainty evidence), but the evidence is very uncertain. In absolute and unadjusted terms, the DFS was 19.3 months in the standard surgery group, 15.8 in the PDS group and 15.9 months in the IDS group. All studies were at critical risk of bias and we only identified very low-certainty evidence for all outcomes reported in the review. Perioperative mortality, adverse events and quality of life (QoL) outcomes were either not reported or inadequately reported in the included studies. Two studies reported perioperative mortality (death within 30 days of surgery), but they did not use any statistical adjustment. In total, there were only four deaths within 30 days of surgery in both studies. All were observed in the standard surgery group, but we did not report a risk ratio (RR) to avoid potentially misleading results with so few deaths and very low-certainty evidence. Similarly, one study reported postoperative morbidity, but the authors did not use any statistical adjustment. Postoperative morbidity occurred more commonly in women who received ultra-radical surgery compared to standard surgery, but the certainty of the evidence was very low. AUTHORS' CONCLUSIONS We found only very low-certainty evidence comparing ultra-radical surgery and standard surgery in women with advanced ovarian cancer. The evidence was limited to retrospective, NRSs and so is at critical risk of bias. The results may suggest that ultra-radical surgery could result in improved OS, but results are based on very few women who were chosen to undergo each intervention, rather than a randomised study and intention-to-treat analysis, and so the evidence is very uncertain. Results for progression/DFS were inconsistent and evidence was sparse. QoL and morbidity was incompletely or not reported in the three included studies. A separate prognostic review assessing residual disease as a prognostic factor in this area has been addressed elsewhere, which demonstrates the prognostic effect of macroscopic debulking to no macroscopic residual disease. In order to aid existing guidelines, the role of ultra-radical surgery in the management of advanced-stage ovarian cancer could be addressed through the conduct of a sufficiently powered, RCT comparing ultra-radical and standard surgery, or well-designed NRSs, if this is not possible.
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Affiliation(s)
- Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| | - Patience T Kunonga
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Raj Naik
- Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, UK
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An K. Psychosocial Factors and Psychological Characteristics of Personality of Patients with Chronic Diseases Using Artificial Intelligence Data Mining Technology and Wireless Network Cloud Service Platform. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8418589. [PMID: 35463263 PMCID: PMC9020898 DOI: 10.1155/2022/8418589] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022]
Abstract
It was to explore the application value of health cloud service platform based on data mining algorithm and wireless network in the analysis of psychosocial factors and psychological characteristics of personality of patients with chronic diseases. Based on the demand analysis of cloud service platform for chronic diseases, a health cloud service platform including three modules was established: support layer, application layer, and interaction layer; and K-means algorithm and Apriori algorithm were used to mine and process data. The changes of pulse wave and EEG signal of epileptic seizures before and after processing by wireless network health cloud service platform were analyzed. 42 patients with idiopathic generalized epilepsy were selected as the research subjects, and 40 volunteers with normal physical examination during the same period were selected as the control group. The differences in the basic clinical characteristics data, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Symptom Checklist 90 (SCL-90), and Eysenck Personality Questionnaire-Revision Short Scale for Chinese (EPQ-RSC) were compared between the two groups. It was found that the initial EEG signals of epileptic patients had noise pollution before and after the seizure, and the noise in the EEG signals was filtered out after digital technology processing in the cloud service platform. The maximum number of epileptic patients aged 18∼30 years was 17 (40.48%), and the mean scores of HAMD and HAMA scales in the epileptic group were significantly higher than those in the control group (P < 0.001). The total score of SCL-90, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychosis in the epilepsy group were obviously higher than those in the control group (P < 0.01). The mean value of EPQ-RSC and neuroticism (N) was clearly higher (P < 0.05), the mean value of extroversion (E) was significantly lower (P < 0.01), and the mean value of Lie Scale was significantly higher (P < 0.05) in the epileptic group in contrast with those in the control group. It indicates that the cloud service platform for chronic diseases based on artificial intelligence data mining technology and wireless network has potential application value. Epilepsy patients with chronic diseases should be paid more attention to their psychosocial factors and psychological characteristics of personality in the treatment process.
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Affiliation(s)
- Kangqi An
- School of Psychological and Cognitive Sciences, Peking University, Beijing 100871, China
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7
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Ekmann-Gade AW, Høgdall CK, Seibæk L, Noer MC, Fagö-Olsen CL, Schnack TH. Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study. Gynecol Oncol 2021; 164:120-128. [PMID: 34716025 DOI: 10.1016/j.ygyno.2021.10.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine clinical trends in Denmark for younger and older epithelial ovarian cancer (EOC) patients, focusing on incidence, treatment, and survival changes. METHODS We included a nationwide cohort diagnosed with EOC from 2005 to 2018. We described age-standardized incidence, surgical patterns, residual disease trends, and cancer-specific survival stratified by age (<70 and ≥ 70 years), stage, and period (2005-09, 2010-13, 2014-18). RESULTS We included 7522 patients. The incidence decreased from 16.3 (2005) to 11.4 (2018) per 100,000 woman-years, driven by the younger cohort. While the proportion of patients with stage IIIC-IV disease undergoing primary debulking surgery (PDS) decreased, the proportion of patients having interval debulking surgery (IDS) and no debulking surgery increased significantly. In 2014-18, 36% and 24% had PDS for younger and older patients, respectively, compared to 72% and 62% in 2005-09. In both age cohorts, the proportion of patients debulked to no residual disease increased significantly among patients with stage IIIC-IV and in the total cohort. Two-year cancer-specific survival increased from 75% (2005-09) to 84% (2014-18) for younger patients and from 53% to 66% for older patients. After adjusting for potential confounders, age ≥ 70 was associated with a 1.4-fold increased risk of cancer-specific death (95% confidence interval: 1.2,1.5). CONCLUSIONS The proportion of patients with advanced EOC not undergoing PDS or IDS increased significantly. During the same period, patients debulked to no residual disease, and cancer-specific survival increased. However, a survival gap in favor of the younger patients remains after adjusting for potential confounders.
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Affiliation(s)
| | | | - Lene Seibæk
- Department of Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Calundann Noer
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Tine Henrichsen Schnack
- Department of Gynecology, Rigshospitalet, Copenhagen, Denmark; Department of Gynecology, Odense University Hospital, Odense, Denmark
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Dumas L, Bowen R, Butler J, Banerjee S. Under-Treatment of Older Patients with Newly Diagnosed Epithelial Ovarian Cancer Remains an Issue. Cancers (Basel) 2021; 13:cancers13050952. [PMID: 33668809 PMCID: PMC7956315 DOI: 10.3390/cancers13050952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/28/2023] Open
Abstract
Older women with ovarian cancer have disproportionately poorer survival outcomes than their younger counterparts and receive less treatment. In order to understand where the gaps lie in the treatment of older patients, studies incorporating more detailed assessment of baseline characteristics and treatment delivery beyond the scope of most cancer registries are required. We aimed to assess the proportion of women over the age of 65 who are offered and receive standard of care for first-line ovarian cancer at two UK NHS Cancer Centres over a 5-year period (December 2009 to August 2015). Standard of care treatment was defined as a combination of cytoreductive surgery and if indicated platinum-based chemotherapy (combination or single-agent). Sixty-five percent of patients aged 65 and above received standard of care treatment. Increasing age was associated with lower rates of receiving standard of care (35% > 80 years old versus 78% of 65-69-year-olds, p = 0.000). Older women were less likely to complete the planned chemotherapy course (p = 0.034). The oldest women continue to receive lower rates of standard care compared to younger women. Once adjusted for Federation of Gynaecology and Obstetrics (FIGO) stage, Eastern Cooperative Oncology Group (ECOG) performance status and first-line treatment received, age was no longer an independent risk factor for poorer overall survival. Optimisation of vulnerable patients utilising a comprehensive geriatric assessment and directed interventions to facilitate the delivery of standard of care treatment could help narrow the survival discrepancy between the oldest patients and their younger counterparts.
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Affiliation(s)
- Lucy Dumas
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (L.D.); (J.B.)
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, UK
| | - Rebecca Bowen
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK;
| | - John Butler
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (L.D.); (J.B.)
| | - Susana Banerjee
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (L.D.); (J.B.)
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, UK
- Correspondence:
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Norell CH, Butler J, Farrell R, Altman A, Bentley J, Cabasag CJ, Cohen PA, Fegan S, Fung-Kee-Fung M, Gourley C, Hacker NF, Hanna L, Høgdall CK, Kristensen G, Kwon J, McNally O, Nelson G, Nordin A, O'Donnell D, Schnack T, Sykes PH, Zotow E, Harrison S. Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care. Int J Gynecol Cancer 2020; 30:1748-1756. [PMID: 32784203 PMCID: PMC7656152 DOI: 10.1136/ijgc-2020-001403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65-74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities. OBJECTIVE To compare clinical practice guidelines and patterns of care across seven high-income countries. METHODS A comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by 'distant' stage using Spearman's rho. RESULTS Twenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/'ultra-radical' surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (rs=0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits. DISCUSSION Findings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.
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Affiliation(s)
- Charles H Norell
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, London, UK
| | - John Butler
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, London, UK
- Gynaecology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Rhonda Farrell
- Gynaecological Oncology Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Alon Altman
- Department of Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bentley
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Paul A Cohen
- Department of Gynaecological Oncology, St John of God Health Care, West Perth, Ontario, Australia
| | - Scott Fegan
- Department of Obstetrics and Gynaecology, NHS Lothian, Edinburgh, UK
| | - Michael Fung-Kee-Fung
- Department of Obstetrics, Gynaecology and Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Charlie Gourley
- Cancer Research UK Edinburgh Centre, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Neville F Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
- School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Cardiff, Wales, UK
| | - Claus Kim Høgdall
- Gynecologic Department, The Juliane Marie Centre, Copenhagen, Denmark
| | - Gunnar Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Janice Kwon
- Department of Obstetrics and Gynaecology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Orla McNally
- Oncology and Dysplasia Service, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gregg Nelson
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Andy Nordin
- Department of Gynaecological Oncology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Tine Schnack
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter H Sykes
- Department of Obstetrics and Gynaecology, University of Otago, Dunedin, New Zealand
| | - Ewa Zotow
- Policy & Information, Cancer Research UK, London, UK
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Cabasag CJ, Butler J, Arnold M, Rutherford M, Bardot A, Ferlay J, Morgan E, Møller B, Gavin A, Norell CH, Harrison S, Saint-Jacques N, Eden M, Rous B, Nordin A, Hanna L, Kwon J, Cohen PA, Altman AD, Shack L, Kozie S, Engholm G, De P, Sykes P, Porter G, Ferguson S, Walsh P, Trevithick R, Tervonen H, O'Connell D, Bray F, Soerjomataram I. Exploring variations in ovarian cancer survival by age and stage (ICBP SurvMark-2): A population-based study. Gynecol Oncol 2020; 157:234-244. [PMID: 32005583 DOI: 10.1016/j.ygyno.2019.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aims to evaluate the differences in ovarian cancer survival by age and stage at diagnosis within and across seven high-income countries. METHODS We analyzed data from 58,161 women diagnosed with ovarian cancer during 2010-2014, followed until 31 December 2015, from 21 population-based cancer registries in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and United Kingdom. Comparisons of 1-year and 3-year age- and stage-specific net survival (NS) between countries were performed using the period analysis approach. RESULTS Minor variation in the stage distribution was observed between countries, with most women being diagnosed with 'distant' stage (ranging between 64% in Canada and 71% in Norway). The 3-year all-ages NS ranged from 45 to 57% with Australia (56%) and Norway (57%) demonstrating the highest survival. The proportion of women with 'distant' stage was highest for those aged 65-74 and 75-99 years and varied markedly between countries (range:72-80% and 77-87%, respectively). The oldest age group had the lowest 3-year age-specific survival (20-34%), and women aged 65-74 exhibited the widest variation across countries (3-year NS range: 40-60%). Differences in survival between countries were particularly stark for the oldest age group with 'distant' stage (3-year NS range: 12% in Ireland to 24% in Norway). CONCLUSIONS International variations in ovarian cancer survival by stage exist with the largest differences observed in the oldest age group with advanced disease. This finding endorses further research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease.
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Affiliation(s)
- Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France.
| | - John Butler
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England, UK
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Mark Rutherford
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Aude Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Eileen Morgan
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-based Cancer Research, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Charles H Norell
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Samantha Harrison
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, 1276 South Street, Halifax B3H 2Y9, NS, Canada
| | - Michael Eden
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Brian Rous
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Andy Nordin
- East Kent Hospitals University National Health Service Foundation Trust, Kent, England, UK
| | - Louise Hanna
- Velindre University National Health Service Trust, Cardiff, Wales, UK
| | - Janice Kwon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer, Department of Surgical Oncology, Vancouver, British Columbia, Canada
| | - Paul A Cohen
- University of Western Australia, Division of Obstetrics and Gynaecology, Crawley, Western Australia, Australia; St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, 2210 2nd Street, SW, Calgary, AB T2S 3C3, Canada
| | - Serena Kozie
- Registry Department, Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada
| | - Gerda Engholm
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Prithwish De
- Surveillance & Cancer Registry, Cancer Care Ontario, 620 University Ave., Toronto, ON M5G 2L7, Canada
| | - Peter Sykes
- University of Otago, Christchurch, New Zealand
| | - Geoff Porter
- Canadian Partnership Against Cancer, 145 King Street West, Suite 900, Toronto, Ontario M5H 1J8, Canada
| | - Sarah Ferguson
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork T12 CDF7, Ireland
| | - Richard Trevithick
- Western Australia Cancer and Palliative Care Network Policy Unit, Health Networks Branch, Department of Health, Perth, Western Australia, Australia
| | - Hanna Tervonen
- Cancer Institute NSW, PO Box 41, Alexandria NSW 1435, Australia
| | - Dianne O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
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11
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van Walree IC, Bretveld R, van Huis-Tanja LH, Louwers JA, Emmelot-Vonk MH, Hamaker ME. Reasons for guideline non-adherence in older and younger women with advanced stage ovarian cancer. Gynecol Oncol 2020; 157:593-598. [PMID: 32171566 DOI: 10.1016/j.ygyno.2020.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to assess the reasons for guideline non-adherence in women with advanced stage ovarian cancer and whether these reasons differ according to age. METHODS All women diagnosed with advanced stage ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) IIb-IV, between 2015 and 2018 were selected from the Netherlands Cancer Registry. Treatment patterns and reasons for guideline non-adherence were analyzed according to age groups. RESULTS 4210 women were included, of whom 34%, 33%, 26%, and 8% were aged <65, 65-75, 75-85, and ≥85 years respectively. With advancing age, less women received guideline-adherent treatment (decreasing from 70% to 2% in women aged <65 and ≥85 years respectively) and more women received best supportive care only (ranging from 4% to 69% in women aged <65 and ≥85 years respectively). The most prevalent reasons for guideline non-adherence differed according to age and included patient preference in older women, and functional status and extent of disease in younger women. CONCLUSIONS Most older women did not receive guideline-adherent care and patient preference was the most common reason for this decision. This knowledge provides insight in the current treatment decision-making process and highlights the importance of eliciting patient treatment preferences. Further prospective research is necessary to study the underlying motivation for women to decline guideline care and the extent to which shared decision-making influences treatment choice.
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Affiliation(s)
- I C van Walree
- Department of Internal Medicine, Diakonessenhuis Utrecht, the Netherlands.
| | - R Bretveld
- Netherlands Comprehensive Cancer Organisation, the Netherlands
| | - L H van Huis-Tanja
- Department of Internal Medicine, Diakonessenhuis Utrecht, the Netherlands
| | - J A Louwers
- Department of Gynecology, Diakonessenhuis Utrecht, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Center, Utrecht, the Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
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