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

Objectives: A 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 Methods: Data were obtained from California Cancer Registry from 1994 to 1996. Kaplan-Meier and Cox proportional hazard methods were used.

Results: Of 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).

Discussion: A 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.